孙文垣治程两峰，与乃侄有芥蒂，偶饮侄家，归觉腹中满，呕哕不宁，次日，面目皆黄，恶寒发热。医作
疟治，五心加热，下午潮热烦躁，且鼻衄腹痛，大便黑如墨，吐黑血如烂猪肺者碗许，状如中蛊，心疑乃侄毒
之。召医，率见其目珠如金，面若熏橘，腹大有块，如盘且坚硬，两足浮肿，四肢冷，小水赤，饮食不思，皆
辞不药。举家号泣，欲争哄。诊之，其脉左涩右滑。滑主痰饮，涩主有瘀血，所吐下皆瘀之验，非蛊也。彼谓
平生颇谨疾。曰∶怒则伤肝，甚则呕血，不呕则瘀于经络，满而溢也。彼乃悟。用当归尾三钱，赤芍、丹皮、
川芎各一钱五分，元胡索、五灵脂、桃仁各一钱，滑石、茜根各二钱，煎饮，下黑物甚多。腹仍痛，块未软，
前方加青皮、山楂、酒蒸大黄，服之大便三次，所去皆痰与瘀。自此腹减块消黄退，足尚肿，改用六君子加泡
姜、茜根、滑石、青蒿而愈。
萧万舆表侄媳脾胃素热，因冒风邪，目涩鼻干，自用姜汤，连三晨咯血数口，又恣饮藕汤，益增烦胀。夫
所谓外感者，从外而入，必令从外而出，姜汤独力，既难奏效，藕汤凉涩，复闭外邪。用解表剂，入芩、连、
花粉，一剂而愈。
姜子社少妇，潮热喘咳，经水涩少，每郁则膈胀拒食，偶啖辛热，咯血口干，脉弦滑微数。盖甫笄阴血未
充，五火易动，因循不治，亦能成瘵。以六味加黄芩、炙草、知母、麦冬、阿胶为丸，服至月余，诸症如失。
孙文垣治汪希明，年弱冠，性躁，素有痰火，旧曾吐血。医用收涩之剂太早，至瘀流滞经络。且为灸肺 、
膏肓，咳不能唾。又误作风邪，投发散之剂，不思火盛得风，其势愈炽，血从口鼻喷出，势如涌泉。诊之，六
脉洪数，身热而烦，又时当三伏，内外之火夹攻，非釜底抽薪之法，难夺其上涌之势，乃以三制大黄三钱，石
膏五钱，黄连、茜根、滑石各二钱，女贞一钱，急煎饮之。大便微行二次，血来少缓，即用石膏、滑石、冬青
子各三钱，旱莲草、茜根各二钱，黄连、山栀、贝母各二钱，茅根五钱，煎服，血乃止。后遇大便燥结，进当
归龙荟丸，咳嗽则与二冬、二母、栝蒌、白芍、黄芩、茅根、黄连、茜草之类，全瘳。夫病有六不灸，火盛者
不灸。此由误灸几殒，书之以为好灸者戒。
臧六老，上吐血，下泻血，胸膈背心皆胀。原因脑怒，又伤犬肉，故发热而渴。医者皆作阴虚火动，为之
滋阴降火，病愈甚。诊之，两关俱洪滑有力，此肝脾二经有余症也。此怒甚伤肝之呕血，并下泄，胸背胀痛，
瘀血使然。脾为犬肉所伤，故不能统血。今误用苦寒之剂，是以脾愈伤而上焦血愈滞，惟调气健脾兼之消导，
则万全矣。六老曰∶人皆谓劳怯，故发热吐红血，上吐阳络伤也，血下行，阴络伤也，阴阳俱伤，法当不治，
今谓非阴虚何也？曰∶脉数无力者为阴虚，今洪滑有力。凡阴虚之热，发于申酉间，夜半而退，如潮汛然，谓
之潮热，今热不分昼夜，安得谓之阴虚？乃与山楂、香附、枳实调气消导为君，丹参、丹皮、桃仁、滑石、茅
根化瘀为臣，黄连、芦根解犬肉之热为佐，四帖，胸背宽，血吐止。惟腹中不舒，仍以前药同丹溪保和丸与之，
四帖，下黑秽半桶而愈。（辨症分明。）
陆养愚治少司马陆北川，原有痰火，因感怒后，触大怒，夜热咳嗽见红，先服童便数钟，血止，嗽亦不甚。
清晨，复吐血甚多，而嗽亦频，医谓年高浓于房事，投滋阴降火，犀角地黄汤及六味加知、柏之类，已五日，
喘急倚息不眠，畏寒特甚。脉之，两寸关浮洪而滑，两尺稍沉数，曰∶此感冒未经解散，今将入里。盖初以童
便阴凉遏之，致外感内郁，二火皆无所泄，故逆而冲上也。脉实症实，终属有余之邪。今尚畏寒，表症犹在，
而喘急冲逆，阳明之热尤甚，宜合攻之，解散在经之邪，整肃胃府之热，则诸症自释。因用干葛、石膏为君，
桑皮、前胡、苏子、杏仁、薄荷、黄芩为佐，炙细甘草、木通为使，二剂减十之七。寸关已平，尺尚洪，乃以
前剂加元明粉三钱，一剂出稠秽甚多，诸症全愈矣。
陆肖愚治妻兄费光宇，七月间，薄暮归家，饮酒数杯，心口便觉不快，随吐，吐后出痰沫盆许，继之以血
碗余，头眩眼黑，遍身汗出如雨，渐发热，但可静卧，稍动即吐，吐即有血，口极渴，而汤饮不敢进，或与药
亦吐，而血随涌出。脉之，数大无伦，按之则虚，面如烟尘，曰∶此劳心而兼伤暑热也。血由吐出，吐因动发。
令无动，以井水调辰砂益元散，徐饮之，约水一 ，药八九钱，遂睡，半日方醒，人事清爽，热退吐止。但倦
甚，以生脉散调理数日而愈。（雄按∶生脉散未妥。）
钟鸣宇苦志萤窗，忽吐血碗许，医以芩、连、栀、柏、生地、白芍辈投之，一帖而止。后数日，喉中复有
血腥，似有汹涌之意，又投前剂，亦一帖而止。自此，渐发热，咳嗽痰红。又以吐血为阴虚火旺，以滋阴清火
疗之，逾两月不减，而大便不洁，面黄带青，喘促声哑，不能仰卧，胸膈痛应于背。脉之，两寸不起，两关尺
沉迟，曰∶寸脉不起，上焦有痛也；关脉沉迟，中下有寒也。用元胡索、红花、苏木、茅根、丹皮、紫菀、桑
皮、贝母、枇杷叶，大料浓煎，徐徐服之。又以白术、干姜、茯苓、泽泻、好陈米为丸，日三服。煎药仅二剂
而喘痛减，又二剂而声稍清，丸药约二钱而泻止，十日俱瘳，以补气养荣汤调理之。
闵巽峰性躁急，素有痰火，三月间患吐血，医以涩药止之，血止而喉常有腥气。至六月，医令乘伏天灸之，
曰∶自此永不发矣。忽一日，血从口鼻喷出，势如泉涌。脉之，六部皆洪大而稍数，乃用芩、连、石膏、丹皮、
红花、犀角等药，进二剂不甚减。以润字料合桃仁丸之，顿服五钱，少顷，又进三钱，五更连下数行，出稠痰
瘀血缶许，身凉血止，得稍睡。以前汤加生地，数剂，又去犀角、红花，加天麦冬、花粉，便结则用前丸，调
理五十日，血全止，半年复故。
潘碧泉女，年十八，经行有拂意事，悲忿极，血行一日即止。后患吐血，每吐碗许，日晡潮热，饮食不思，
大便不通。医以犀角地黄汤投之，心下痞胀，呕吐或痰或血或酸水，胸胁亦时时胀痛。脉之，洪大而弦，此有
瘀血也。旧者凝滞，则新者渐积，故溢而妄行，法宜通其瘀血，则自归经矣。以润字丸配桃仁、红花合丸之，
日进三服，另以调气养荣汤间投之，去瘀垢甚多，热退经行，吐血即止。
陆祖愚治俞姓人，素性躁急善怒，一日忽吐血七八碗，身热气喘，腹胀满，终夜不寐，饮食不进，自用滋
阴止血药而愈甚。脉之，六部俱如弹石，将及七至，右关更劲，腹上一搽，血即喷出，此有余之症也，乃与小
陷胸汤二剂，加铁锈水，明日减半。大便第七八日不行，必下之方愈，以润字丸加桃仁合丸之，书其帖曰止血
丸。服之，夜下瘀血宿垢半桶，而吐血顿止矣。
吴实子年十六，患吐血，面色萎黄，形容憔悴，泄泻肢肿，向有遗精，近来更甚，六脉虚数。或服清凉之
剂，红减而发热作呕，肿泻更甚，诚所谓以寒凉治，百无一生也。乃与开胃温中健脾养血之剂，月余，便实肿
消，热退食进。后用六味丸加知、柏、杜仲、枸杞、牡蛎、麦冬，五更吞服，又与煎药五十余剂，诸症脱然。
滁州题使君云∶其族娣为尼，住新淦一寺，忽苦暴吐血，发寒热，欲作劳气而未成，医者不肯治。偶一士
大夫说，用童便调下花蕊石散，不数日而愈。此后亦多有人服得效。（是斋方《医说续编》。）花蕊石一斤，上
色硫黄四两和匀，先用泥封固，瓦罐一个，入二药，仍封固瓦罐候干。如急用，以焙笼内炙干，用炭 炙，去
火，次日取水细研，每服一钱，童便热酒下。并治胎衣不下，及瘀血内积，及大小便不通如神。（《良方》。）
喻嘉言治黄湛侯，素有失血症，一日晨起至书房，陡暴一口，倾血一盆，喉间气涌，神思飘荡，壮热如蒸，
颈筋粗劲。诊其脉，尺中甚乱，曰∶此昨晚大犯房劳，自不用命也。因出验血，见色如太阳之红。其仆云∶此
血如宰猪后半之血，其来甚远，不谓痴人有此确喻。（君以仆为痴，不知君更痴于仆也。或曰∶喻不痴而
何以为医？）再至寝室谓曰∶少阴之脉萦舌本，少阴者，肾也。今肾中之血汹涌而出，舌本已硬，无法可以救急。
因谛思良久，曰∶只得一法，不得已用丸药一服，坠安元气，若得气转丹田，尚可缓图。因煎人参浓汤，下黑
锡丹三十粒，喉间 有声，渐下入腹。少顷，舌柔能言，但声不出，亟用润下之剂，以煎前药。遂以阿胶一味，
重两许，溶化，分三次热服，溉以热汤，半日服尽，身热渐退，颈筋渐消，进粥。与补肾药连服五日，声出喉清，
人事向安。但每日尚出深红之血盏许，因时令大热，遵《内经》热淫血溢，治以咸寒之旨，于补肾药中多加秋
石，服之遂
愈。
刘筠枝长男，病失血，岁二三发，后所出渐多，咳嗽发热，食减肌消。夏秋间，复发寒热如疟，每夜达曙，
得微汗始解。后寒热稍减，病转下利，服以参、术，胸膈迷闷，喉音窒塞。服茯苓、山药及收制红铅末，下黑
血块数升，胸喉顿舒，面容亦转。乃翁神之，以为竹破竹补之法也，即用桂、附二剂，于是下利，一昼夜十数
行，饮食难入，神识不清。诊之，脾脉大而浮，肾脉小而乱，肺脉沉而伏。命疏方并问何症？曰∶此症患在亡
阴，反用峻药之剂，行期在立冬后三日，以今许之，不过信宿，无以方为也。经云∶暴病非阳，久病非阴，则
数年失血，其为阳盛阴虚无疑。况食减而血不生，渐至肌削，而血日槁，虚者益虚，盛者益盛，势必阴火大炽，
上炎而伤肺金，咳嗽生痰，清肃下行之令尽失。由是肾水无母气以生，不足以荫养百体，肌肉瘦损，每申酉时
洒淅恶寒，转而热至天明，微汗始退。正如夏日炎蒸，非雨不解，身中之象，明明有春夏无秋冬，治宜亟使金
寒水冷，以杀其势。乃因下利而用参、术，不知肺热已极，止有从皮毛透出一路。今补而不宣，势必移于大肠，
传为肠 矣。至饮红铅下黑血者，盖阳分之血，随清气行者久已呕出，其阴分之血，随浊气行至胸中，为膜原
所蔽，久瘀膈间者，得经水阴分下出之血，引之而走下窍，声应气求之妙也。久积暂宽，面色稍转，言笑稍适
者，得其下之之力，非得其补之力也。乃平日预蓄此药，必为方士所惑，见为真阳大药，遂放胆加用桂、附，
致尽劫其阴，惜此时未得止之之剂。今则两尺脉乱，火燔而泉竭，脾胃脉浮，下多阴亡，阳无所附，肺脉沉伏，
金气缩敛不行，神识不清，魄已先丧矣，宁可挽回哉。
张景岳治倪孝廉，年逾四旬，素以思虑伤脾，时有呕吐之症，过劳即发，服理阴煎、温胃饮之属即愈。近
于暑末时，因连日交际，致劳心脾，遂上为吐血，下为泻血，俱大如手片，或紫或红，其多可畏。医谓因劳而火
起心脾，兼之暑令，二火相济，所以致此，乃与犀角、地黄、童便、知母之属两剂，其吐愈甚，脉益紧数，困
惫垂危。乃云∶脉症俱逆，不可为也。诊之，则情势俱剧，用人参、熟地、干姜、甘草四味，大剂与之。初服
如旧，次服觉呕吐稍止，脉亦略有生意，再加炮姜、附子各二钱，人参、熟地各一两，白术四钱，炙甘草一钱，
茯苓二钱。黄昏与服，竟得大睡，觉而血呕皆止，遂以温补调理，旬日复健。如此脉症，由劳倦伤脾，而气虚
不能摄血，时当火令，而症非火也，误用寒凉，脾败而死矣。后有史姓等数人，皆同此症，悉以六味回阳饮活
之。（叶天士曰；呕吐之症，不讲参、术同用，而用熟地、干姜，岂能见效？又曰∶幸加白术，凡呕吐乃脾胃之
病，不用白术、茯苓、广皮，而以归、地为治，其见效亦偶然耳。又曰∶劳伤脾胃而吐血，寒凉固不可用，热
药亦不宜用，恐其助火咳嗽也。惟归脾、四君、六君加减治之，最为万妥。如景岳之六味回阳饮，自称其妙，
亦纸上空言，未能见之实事。劳字之义，两火上炎，岂非有火乎？但宜温养，不可寒凉，故经云∶劳者温之。
温存以养，使气自充，非讲热药以温养也。）
李士材治张鸣之，吐血两年，面色萎黄，潮热嗽咳，膈有微痛，脉数而沉，且搏痛不可按，而甚于夜分，
是坚血积蓄，非大下之不可。又以久病，未敢峻利，用郁金、降真、归、地、山甲、蓬术、人参，下血如漆者
数次而痛减。月余复病，此病重而药轻也，乃以大黄、干漆、蓬术、人参，下血如漆者数次而痛减。月余复病，
此病重而药轻也，乃以大黄、干姜、蓬术、郁金、山甲、肉桂、归尾、桃仁、虻虫为丸，每日早起服参、 之
剂，午后服丸药钱许，十日血积大下数次而安。（此案出《医方》。）
章氏子吐血发热，遗精盗汗，形肉衰削，先有医戒之勿服人参，若误服无药可救，治勿效。延李诊，曰∶
孙文垣治疗程两峰，他与他的侄子有嫌隙，偶然在侄子家饮酒，回家后觉得腹部胀满，恶心呕吐不安稳。第二天，面部和眼睛都发黄，怕冷发热。医生当作疟疾治疗，导致五心烦热，下午出现潮热烦躁，并且鼻出血、腹痛，大便黑得像墨一样，吐出像烂猪肺一样的黑血约一碗，症状像中了蛊毒，心里怀疑是侄子下毒。召集医生诊治，大家都看到他的眼珠像金子一样黄，面色像被烟熏过的橘子，腹部有大块肿块，像盘子一样大且坚硬，双脚浮肿，四肢冰冷，小便赤红，不想吃东西，都推辞不治疗。全家痛哭流涕，想要争吵闹事。孙文垣诊脉，左手脉涩，右手脉滑。滑脉主痰饮，涩脉主有瘀血，所吐出的和下排的都是瘀血的验证，不是蛊毒。他说自己平时很注意养生防病。孙文垣说：“发怒会伤肝，严重时会呕血，如果不呕出来，就会瘀滞在经络中，充满后溢出。”他才恍然大悟。使用当归尾三钱，赤芍、丹皮、川芎各一钱五分，元胡索、五灵脂、桃仁各一钱，滑石、茜根各二钱，煎水服用，排出很多黑色物质。腹部仍然疼痛，肿块没有变软，前方中加入青皮、山楂、酒蒸大黄，服用后大便三次，排出的都是痰和瘀血。从此腹部减小，肿块消失，黄疸退去，脚还肿，改用六君子汤加泡姜、茜根、滑石、青蒿而痊愈。
萧万舆的表侄媳脾胃素来有热，因为冒受风邪，眼睛干涩鼻子干燥，自己用姜汤，连续三个早晨咯出几口血，又恣意饮用藕汤，更加增加了烦闷胀满。所谓外感病邪，是从外面侵入，必须让它从外面排出，姜汤力量单一，既难奏效，藕汤性凉且涩，反而闭塞了外邪。使用解表剂，加入黄芩、黄连、天花粉，一剂就痊愈了。
姜子社的年轻妻子，出现潮热喘咳，月经量少不畅，每次郁结时胸膈胀满拒绝进食，偶尔吃辛辣热的食物，就咯血口干，脉象弦滑微数。刚成年阴血未充盈，五志之火容易妄动，因循拖延不治疗，也能形成虚劳痨病。用六味地黄丸加黄芩、炙甘草、知母、麦冬、阿胶制成丸药，服用一个多月，各种症状消失。
孙文垣治疗汪希明，年纪刚二十岁，性格急躁，素有痰火，以前曾吐过血。医生使用收敛固涩的药物太早，导致瘀血流滞经络。而且给他灸肺俞穴、膏肓穴，咳嗽不能咳出痰液。又误认为是风邪，投用发散药物，没想到火势旺盛遇到风邪，势头更加猛烈，血液从口鼻喷出，势如涌泉。诊脉，六脉洪大数急，身体发热而烦躁，又正值三伏天，内外之火夹攻，不用釜底抽薪的方法，难以遏制其上涌的势头，于是用三制大黄三钱，石膏五钱，黄连、茜根、滑石各二钱，女贞子一钱，急煎服用。大便微行两次，血流稍缓，立即用石膏、滑石、冬青子各三钱，旱莲草、茜根各二钱，黄连、山栀、贝母各二钱，白茅根五钱，煎服，血才停止。后来遇到大便燥结，进服当归龙荟丸，咳嗽则给予天冬、麦冬、知母、贝母、瓜蒌、白芍、黄芩、白茅根、茜草之类，完全治愈。疾病有六种情况不宜艾灸，火盛者不可灸。这由误灸几乎丧命，记录下来作为喜欢艾灸者的警戒。
臧六老，上部吐血，下部泻血，胸膈和背心都胀满。原因是大怒，又吃了狗肉，所以发热口渴。医生都当作阴虚火动，为他滋阴降火，病情更加严重。诊脉，两手关脉都洪滑有力，这是肝脾二经有余的症状。这是大怒伤肝导致的呕血并下泄，胸背胀痛，是瘀血造成的。脾脏被狗肉所伤，所以不能统摄血液。现在误用苦寒药物，因此脾更受伤而上焦血更加停滞，只有调气健脾兼以消导，才能万全。臧六老说：“人们都说劳怯，所以发热吐红血，上部吐是阳络受伤，血下行是阴络受伤，阴阳俱伤，按法应当不治，现在为什么说不是阴虚呢？”我说：“脉数无力的才是阴虚，现在洪滑有力。凡是阴虚的热，发于申酉之间（下午3-7点），半夜消退，像潮汐一样，称为潮热，现在热不分昼夜，怎么能叫阴虚？”于是给予山楂、香附、枳实调气消导为君药，丹参、丹皮、桃仁、滑石、白茅根化瘀为臣药，黄连、芦根解狗肉之热为佐药，四帖后，胸背宽舒，吐血停止。只有腹中不舒服，仍用前药同丹溪保和丸给他，四帖后，排出半桶黑秽物而痊愈。（辨证分明。）
陆养愚治疗少司马陆北川，原有痰火，因为生气后，又触到大怒，夜间发热咳嗽见红，先服用童便几杯，血止，咳嗽也不怎么厉害了。清晨，又吐很多血，而且咳嗽频繁，医生说年高房事多，投用滋阴降火，犀角地黄汤及六味地黄丸加知母、黄柏之类，已经五天，气喘急促倚靠呼吸无法睡觉，特别怕冷。诊脉，两手寸关脉浮洪而滑，两手尺脉稍沉数，说：“这是感冒未经解散，现在将要入里。起初用童便阴凉遏止，导致外感内郁，二火都没有宣泄途径，所以逆冲而上。脉实症实，终归是有余的邪气。现在还怕冷，表证还在，而气喘急促冲逆，阳明热尤其严重，应该合攻，解散在经之邪，整顿胃府之热，那么各种症状自然解除。于是用葛根、石膏为君药，桑白皮、前胡、苏子、杏仁、薄荷、黄芩为佐药，炙细甘草、木通为使药，两剂减少十分之七。寸关脉已平，尺脉尚洪，于是以前方加玄明粉三钱，一剂排出很多稠厚秽物，各种症状全愈。”
陆肖愚治疗妻兄费光宇，七月间，傍晚回家，喝了几杯酒，心口就觉得不舒服，随即呕吐，吐后吐出痰沫约一盆，接着吐出血碗余，头晕眼花，全身出汗如雨，渐渐发热，只能静卧，稍微一动就吐，吐就有血，口极渴，但不敢喝汤水，或者给药也吐，而血随涌出。诊脉，数大无比，按之则虚，面色像烟尘，说：“这是劳心兼伤暑热。血由吐出，吐因动引发。让他不要动，用井水调辰砂益元散，慢慢喝他，大约水一杯，药八九钱，于是睡着，半天才醒，人事清爽，热退吐止。只是疲倦得很，用生脉散调理几天而痊愈。（徐灵胎按：生脉散不妥当。）”
钟鸣宇刻苦读书，忽然吐血一碗，医生用黄芩、黄连、栀子、黄柏、生地、白芍等药投喂，一帖就止住了。过了几天，喉咙中又有血腥气，似乎有汹涌之意，又投前药，也是一帖就止住。从此，渐渐发热，咳嗽痰中带红。又以吐血为阴虚火旺，用滋阴清火治疗，超过两个月不见减，而且大便不洁，面色黄带青，喘促声哑，不能仰卧，胸膈痛牵引到背部。诊脉，两手寸脉不起，两手关尺脉沉迟，说：“寸脉不起，上焦有瘀痛；关脉沉迟，中下有寒。用元胡索、红花、苏木、白茅根、丹皮、紫菀、桑白皮、贝母、枇杷叶，大量浓煎，慢慢服用。又用白术、干姜、茯苓、泽泻、好陈米制成丸药，每天服三次。煎药仅两剂而喘痛减轻，又两剂声音稍清，丸药约两钱而泻止，十天全部痊愈，用补气养荣汤调理。”
闵巽峰性格急躁，素有痰火，三月间患吐血，医生用涩药止住，血止而喉咙常有腥气。到了六月，医生让他在伏天艾灸，说：“从此永不发作了。”忽然有一天，血从口鼻喷出，势如泉涌。诊脉，六部皆洪大而稍数，于是用黄芩、黄连、石膏、丹皮、红花、犀角等药，进服两剂不甚减。用润字料合桃仁丸，顿服五钱，一会儿，又进三钱，五更连下数次，排出稠痰瘀血缶许，身凉血止，得以稍睡。用前方加生地，数剂，又去掉犀角、红花，加天冬、麦冬、天花粉，便秘则用前丸，调理五十日，血全止，半年后复发。
潘碧泉的女儿，十八岁，经期遇到不如意的事，悲愤至极，血行一天就停止了。后来患吐血，每次吐一碗左右，下午潮热，不想吃东西，大便不通。医生用犀角地黄汤投喂，心下痞胀，呕吐或痰或血或酸水，胸胁也时时胀痛。诊脉，洪大而弦，这是有瘀血。旧的凝滞，新的逐渐积聚，所以溢出妄行，法宜通其瘀血，则自然归经。用润字丸配桃仁、红花合丸，每天进服三次，另外用调气养荣汤间隔投喂，排出很多瘀垢，热退经行，吐血即止。
陆祖愚治疗姓俞的人，素性急躁易怒，一天忽然吐血七八碗，身热气喘，腹胀满，整夜不睡觉，不吃东西，自己用滋阴止血药而加重。诊脉，六部都像弹石，将近七至，右关更强劲，腹部上一擦，血就喷出，这是有余的病症，于是给小陷胸汤两剂，加铁锈水，明天减半。大便第七八天不行，必须下之才愈，用润字丸加桃仁合丸，写处方名为止血丸。服用后，夜里排出瘀血宿垢半桶，而吐血顿时停止。
吴实子十六岁，患吐血，面色萎黄，形体憔悴，泄泻肢肿，向来有遗精，近来更甚，六脉虚数。有人服清凉药剂，红色减少但发热作呕，肿胀腹泻更严重，诚所谓用寒凉治疗，百无一生。于是给予开胃温中健脾养血药剂，月余，大便成形肿胀消，热退食进。后用六味地黄丸加知母、黄柏、杜仲、枸杞、牡蛎、麦冬，五更吞服，又与煎药五十余剂，各种症状脱然痊愈。
滁州题使君说：他的族弟妹做尼姑，住在新淦的一个寺庙，忽然苦于暴吐血，发寒热，想作劳气而未成，医生不肯治。偶然一个士大夫说，用童便调下花蕊石散，不几天而痊愈。此后也有人服用有效。（出自《医说续编》。）花蕊石一斤，上等硫黄四两和匀，先用泥封固，瓦罐一个，放入二药，仍封固瓦罐候干。如果急用，在焙笼内炙干，用炭火炙，去火，次日取水细研，每服一钱，童便热酒送下。并治胎衣不下，及瘀血内积，及大小便不通如神。（出自《良方》。）
喻嘉言治疗黄湛侯，素有失血症，一天早晨起床到书房，突然暴吐一口，倾血一盆，喉间气涌，神思飘荡，壮热如蒸，颈筋粗劲。诊脉，尺中甚乱，说：“这是昨晚大犯房劳，不自爱惜。拿出检验的血，见颜色像太阳的红。他的仆人说：‘这血像宰猪后半身的血，来源很远，没想到痴人有这样确切的比喻。’（您认为仆人痴，不知道您比仆人更痴。有人说：喻先生不痴，怎么能成为医生？）再到寝室对他说：‘少阴经脉环绕舌本，少阴就是肾。现在肾中的血汹涌而出，舌本已经硬，没有办法可以救急。’仔细思考良久，说：‘只得一法，不得已用丸药一服，坠安元气，如果得气转丹田，还可以缓图。’于是煎人参浓汤，送下黑锡丹三十粒，喉间有声，渐渐下入腹。一会儿，舌柔能言，但声音出不来，紧急用润下药剂，煎前药。就用阿胶一味，重一两许，溶化，分三次热服，灌以热汤，半天服尽，身热渐退，颈筋渐消，进粥。与补肾药连服五日，声音出喉清，人事向安。但每天还出深红之血一盏许，因时令大热，遵《内经》热淫血溢，治以咸寒的宗旨，在补肾药中多加秋石，服用遂愈。
刘筠枝的长子，患失血，一年二三次发作，后来所出渐多，咳嗽发热，食减肌消。夏秋间，又复发寒热如疟，每晚到天亮，得微汗才解。后来寒热稍减，病转下利，服用参、术，胸膈迷闷，喉音窒塞。服用茯苓、山药及收制红铅末，下黑血块数升，胸喉顿舒，面容也转。父亲认为这是竹破竹补的方法，就用桂、附二剂，于是下利，一昼夜十数次，饮食难入，神识不清。诊脉，脾脉大而浮，肾脉小而乱，肺脉沉而伏。让人开方并问什么症？说：“此症患在亡阴，反用峻药之剂，行程在立冬后三日，以今天算起，不过两晚，没有方子了。经云：暴病非阳，久病非阴，则数年失血，其为阳盛阴虚无疑。何况食减而血不生，渐至肌削，而血日槁，虚者益虚，盛者益盛，势必阴火大炽，上炎而伤肺金，咳嗽生痰，清肃下行之令尽失。由此肾水无母气以生，不足以荫养百体，肌肉瘦损，每申酉时洒淅恶寒，转而热至天明，微汗始退。正如夏日炎蒸，非雨不解，身体中的景象，明明有春夏无秋冬，治宜亟使金寒水冷，以杀其势。却因为下利而用参、术，不知肺热已极，止有从皮毛透出一路。现在补而不宣，势必移于大肠，传为肠澼。至于饮红铅下黑血者，盖阳分之血，随清气行者久已呕出，其阴分之血，随浊气行至胸中，为膜原所蔽，久瘀膈间者，得经水阴分下出之血，引之而走下窍，声应气求之妙也。久积暂宽，面色稍转，言笑稍适者，得其下之之力，非得其补之力也。乃平日预蓄此药，必为方士所惑，见为真阳大药，遂放胆加用桂、附，致尽劫其阴，可惜此时未得止之之剂。现在则两尺脉乱，火燔而泉竭，脾胃脉浮，下多阴亡，阳无所附，肺脉沉伏，金气缩敛不行，神识不清，魄已先丧矣，宁可挽回哉。”
张景岳治疗倪孝廉，年过四十，素以思虑伤脾，时有呕吐之症，过劳即发，服理阴煎、温胃饮之类的药就痊愈。最近在暑末时节，因为连日交际，致劳心脾，于是上为吐血，下为泻血，都大如手片，或紫或红，其多可畏。医生说是因为劳而火起心脾，兼之暑令，二火相济，所以致此，于是给犀角、地黄、童便、知母之类的药两剂，其吐愈甚，脉益紧数，困惫垂危。于是说：“脉症俱逆，不可为也。”诊脉，则情势俱剧，用人参、熟地、干姜、甘草四味，大剂与之。初服如旧，次服觉呕吐稍止，脉亦略有生意，再加炮姜、附子各二钱，人参、熟地各一两，白术四钱，炙甘草一钱，茯苓二钱。黄昏与服，竟得大睡，觉而血呕皆止，遂以温补调理，旬日复健。如此脉症，由劳倦伤脾，而气虚不能摄血，时当火令，而症非火也，误用寒凉，脾败而死矣。后有史姓等数人，皆同此症，悉以六味回阳饮活之。（叶天士说：呕吐之症，不讲参、术同用，而用熟地、干姜，岂能见效？又说：幸亏加了白术，凡呕吐乃脾胃之病，不用白术、茯苓、广皮，而以归、地为治，其见效亦偶然耳。又说：劳伤脾胃而吐血，寒凉固不可用，热药亦不宜用，恐其助火咳嗽也。惟归脾、四君、六君加减治之，最为万妥。如景岳之六味回阳饮，自称其妙，亦纸上空言，未能见之实事。劳字之义，两火上炎，岂非有火乎？但宜温养，不可寒凉，故经云：劳者温之。温存以养，使气自充，非讲热药以温养也。）
李士材治疗张鸣之，吐血两年，面色萎黄，潮热嗽咳，膈有微痛，脉数而沉，且搏痛不可按，而甚于夜分，是坚血积蓄，非大下之不可。又以久病，未敢峻利，用郁金、降真、归、地、山甲、蓬术、人参，下血如漆者数次而痛减。月余复病，此病重而药轻也，乃以大黄、干漆、蓬术、人参，下血如漆者数次而痛减。月余复病，此病重而药轻也，乃以大黄、干姜、蓬术、郁金、山甲、肉桂、归尾、桃仁、虻虫为丸，每日早起服参、 之剂，午后服丸药钱许，十日血积大下数次而安。（此案出《医方》。）
Sun Wenyuan treated Cheng Liangfeng, who had a grudge against his nephew. After drinking at his nephew's house by chance, he felt abdominal fullness and restless nausea/vomiting upon returning home. The next day, his face and eyes turned yellow, accompanied by aversion to cold and fever. Physicians treated it as malaria (Malaria), which intensified the heat in the five centers (Palms of hands, soles of feet, and chest), causing afternoon tidal fever (Tidal fever occurring in the afternoon) and irritability. He also suffered from epistaxis (Nosebleed), abdominal pain, black stools like ink, and vomited about a bowlful of black blood resembling rotten pig lung. The condition resembled Gu poisoning (Poisoning caused by mythical insects or toxins). Suspecting his nephew had poisoned him, he summoned physicians. All observed that his eyeballs were golden yellow, his face resembled a smoked orange, his abdomen had a large, hard mass like a plate, his legs were edematous, his limbs were cold, his urine was red, and he had no appetite. They all declined treatment. His family wept bitterly and threatened to quarrel. Sun Wenyuan palpated the pulse: left side was choppy (Choppy pulse indicating blood stasis), right side was slippery (Slippery pulse indicating phlegm-fluid retention). A slippery pulse indicates phlegm-fluid; a choppy pulse indicates blood stasis. The vomiting and defecation of dark material were evidence of blood stasis, not Gu poisoning. Cheng stated he usually took good care of his health. Sun said, "Anger injures the Liver. Severe anger causes hematemesis (Vomiting blood); if not vomited, it stagnates in the collaterals, fills up, and overflows." Cheng then understood. Prescription: Radix Angelicae Sinensis Tail (Dangguiwei) 3 qian, Radix Paeoniae Rubra (Chishao), Cortex Moutan (Danpi), Rhizoma Chuanxiong (Chuanxiong) each 1.5 qian, Rhizoma Corydalis (Yanhusuo), Resina Trogopterori (Wulingzhi), Semen Persicae (Taoren) each 1 qian, Talcum (Huashi), Radix Rubiae (Qianggen) each 2 qian. Decocted and drunk. Many black substances were discharged. Abdominal pain persisted, and the mass remained hard. Green Tangerine Peel (Qingpi), Fructus Crataegi (Shanzha), and Rhubarb steamed with wine (Jiu Dahuang) were added to the previous formula. After three bowel movements, phlegm and blood stasis were expelled. Thereafter, the abdomen reduced, the mass disappeared, and jaundice receded. Edema of the legs remained. Formula modified to Six Gentlemen Decoction (Liujunzi Tang) with soaked Ginger (Paojiang), Radix Rubiae, Talcum, and Artemisia Annua (Qinghao), leading to recovery.
Xiao Wanyu's wife's niece had inherent Stomach-Spleen heat. Contracting wind-pathogen, she experienced dry eyes and nose. She self-administered Ginger Decoction for three mornings, coughing up blood several times. She then indulged in Lotus Root Soup, exacerbating irritability and distension. External pathogens enter from outside and must exit from outside. Ginger alone is insufficient; Lotus Root Soup is cooling and astringent, closing the pathogen inside. A releasing exterior formula with Scutellaria Baicalensis (Huangqin), Coptis Chinensis (Huanglian), and Trichosanthes Root (Huafen) cured her in one dose.
The young wife of Jiang Zishe suffered from tidal fever, wheezing, and coughing, with scanty and difficult menstruation. Depression caused chest diaphragm distension and refusal to eat. Occasionally consuming spicy-hot foods triggered hemoptysis (Coughing up blood) and dry mouth. Pulse was wiry-slippery-moderately rapid. Having just reached puberty, Yin-blood was insufficient, making the Five Fires (Pathogenic fires arising from emotional/physiological imbalance) prone to movement. Neglect could lead to consumption disease (Laojie/Tuberculosis-like syndrome). Pill formula: Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Huangqin, Zhi Gancao (Honey-fried Licorice), Zhimu, Maidong, Ejiao. Taken for over a month, symptoms vanished.
Sun Wenyuan treated Wang Ximing, aged twenty, irritable, with inherent Phlegm-Fire and history of hematemesis. Physicians used astringents too early, causing blood stasis to stagnate in collaterals. Additionally, moxa was applied to Feishu (BL13) and Gaohuang (BL43), causing inability to expectorate sputum. Misdiagnosed as wind-pathogen, dispersing agents were given. Fire exacerbated by wind caused blood to spurt from mouth and nose like a geyser. Pulse: six positions were surging-rapid. Body hot and irritable. During the Sanfu days (Dog days), internal and external fire attacked. Only a "pulling wood from under the cauldron" method (clearing heat drastically) could curb the upward surge. Prescription: Three-processed Rhubarb (Sanzhi Dahuang) 3 qian, Gypsum (Shigao) 5 qian, Huanglian, Qianggen, Huashi each 2 qian, Ligustrum Lucidum (Nvzhenzi) 1 qian. Rapidly decocted. Two mild bowel movements occurred, bleeding slowed slightly. Immediate prescription: Shigao, Dongqingzi each 3 qian, Eclipta Prostrata (Hanliancao), Qianggen each 2 qian, Huanglian, Gardenia (Shanzhi), Fritillaria (Beimu) each 2 qian, Imperata Rhizome (Maogen) 5 qian. Decocted and taken; bleeding stopped. Later, for dry stool, Danggui Longhui Wan was used. For cough, Tian Dong, Mai Dong, Zhimu, Beimu, Trichosanthes Fruit (Gualou), Baishao, Huangqin, Maogen, Qiancao were used. Fully recovered. Note: There are six conditions where moxibustion is contraindicated; those with excess fire should not be moxed. This case nearly proved fatal due to erroneous moxibustion, serving as a warning.
Zang Liulao presented with upper hematemesis and lower hematochezia (Bloody diarrhea), with distension in the chest/diaphragm and back. Caused by severe anger and eating dog meat, leading to fever and thirst. Physicians treated as Yin-deficiency with empty-fire, using yin-nourishing and fire-descending methods, worsening the condition. Pulse: both Guan positions were surging-slippery-forceful. This indicated excess syndromes of Liver and Spleen meridians. Anger injured the Liver, causing vomiting blood and lower discharge; chest/back distension was due to blood stasis. Dog meat injured the Spleen, impairing its function of controlling blood. Erroneous use of bitter-cold herbs further injured the Spleen and stagnated Upper Jiao blood. Treatment: Regulate Qi, strengthen Spleen, and promote digestion. Prescription: Hawthorn (Shanzha), Cyperus Rotundus (Xiangfu), Immature Bitter Orange (Zhishi) as Sovereign; Salvia Miltiorrhiza (Danshen), Danpi, Taoren, Huashi, Maogen as Ministers; Huanglian, Reed Rhizome (Lugen) as Assistants. Four doses relieved chest/back distension and stopped bleeding. Abdominal discomfort remained; previous herbs combined with Baohe Wan were given. Four doses resulted in evacuation of half a bucket of black filth; recovered. (Clear differentiation.)
Lu Yangyu treated Lu Beichuan, who had inherent Phlegm-Fire. After anger, night fever, coughing, and hemoptysis occurred. Initial treatment with child's urine stopped bleeding and reduced cough. Next morning, massive hematemesis and frequent coughing returned. Physicians attributed this to age and excessive sexual activity, prescribing yin-nourishing/fire-descending formulas like Xijiao Dihuang Tang and Liuwei Dihuang Wan plus Zhimu/Baihu. After five days, severe dyspnea, orthopnea, insomnia, and extreme aversion to cold developed. Pulse: Cun/Guan floating-surging-slippery; Chi slightly sinking-rapid. Diagnosis: Exterior pathogen unresolved, moving inward. Child's urine cooled and trapped the exterior pathogen, causing internal depression of fire. Pulse and symptoms indicated excess pathogen. Exterior signs (aversion to cold) persisted; interior Yangming heat was severe. Treatment: Release exterior pathogen and clear Stomach heat. Prescription: Kudzu Root (Gegen), Shigao as Sovereign; Mulberry Bark (Sangpi), Peucedanum (Qianhu), Perilla Seed (Suzi), Apricot Seed (Xingren), Mint (Bohe), Huangqin as Assistants; Zhi Gancao, Mutong as Envoys. Two doses reduced symptoms by 70%. Cun/Guan normalized, Chi remained surging. Add Xuanmingfen (Mirabilite) 3 qian to previous formula. One dose evacuated much thick filth; fully recovered.
Lu Xiaoyu treated brother-in-law Fei Guangyu. In July, after drinking at dusk, heart/chest discomfort ensued, followed by vomiting. Vomitus included ~1 basin of frothy phlegm and >1 bowl of blood. Symptoms: dizziness, blurred vision, profuse sweating, gradual fever. Rest alleviated vomiting; movement triggered bloody vomiting. Extreme thirst but unable to retain fluids/medicine. Pulse: extremely rapid-large, empty on pressure. Face smoky. Diagnosis: Heart labor combined with Summerheat injury. Blood loss resulted from vomiting induced by movement. Advice: Rest. Administer Chen Sha Yiyuan San (Cinnabar Yi Yuan Powder) mixed with well water, slowly drunk (~1 cup water, 8-9 qian medicine). Patient slept for half a day, woke refreshed, fever subsided, vomiting stopped. Fatigue remained; treated with Shengmai San (Generate the Pulse Powder) for several days; recovered. (Xu Lingtai notes: Shengmai San is inappropriate here.)
Zhong Mingyu, a diligent scholar, suddenly vomited a bowl of blood. Physicians used Huangqin, Huanglian, Zhizi, Huangbai, Shengdi, Baishao. Bleeding stopped after one dose. Days later, metallic taste in throat suggested impending recurrence; same formula stopped it again. Gradually developed fever, cough, blood-streaked sputum. Treated as Yin-deficiency/Fire-hyperactivity with yin-nourishing/fire-clearing methods for over two months without improvement. Symptoms: unclean stools, yellow-green face, dyspnea, hoarseness, inability to lie supine, chest pain radiating to back. Pulse: Cun non-rising; Guan/Chi sinking-slow. Diagnosis: Non-rising Cun indicates Upper Jiao pain/stasis; sinking-slow Guan/Chi indicates Middle/Lower Jiao cold. Prescription: Yanhusuo, Honghua, Sappan Wood (Sumu), Maogen, Danpi, Asterae Caulis (Ziwan), Sangpi, Beimu, Loquat Leaf (Pipaye) heavily decocted, taken slowly. Pill: Baizhu, Ganjiang, Fuling, Ze Xie, old rice. Taken three times daily. Decoction (2 doses) reduced dyspnea/pain; voice cleared (2 more doses). Pills (2 qian) stopped diarrhea. Recovered in 10 days; maintained with Buqi Rongying Tang.
Min Xunfeng, irritable with inherent Phlegm-Fire, had hematemesis in March. Astringents stopped bleeding but left metallic taste in throat. In June, physician advised moxibustion during Sanfu days, claiming permanent cure. Suddenly, blood spurted from mouth/nose. Pulse: six positions surging-large-moderately rapid. Prescription: Huangqin, Huanglian, Shigao, Danpi, Honghua, Xijiao. Two doses ineffective. Run Zi pill combined with Taoren pill administered (5 qian initially, then 3 qian). At dawn, multiple evacuations of thick phlegm/blood stasis occurred. Body cooled, bleeding stopped, sleep achieved. Previous decoction + Shengdi for several doses; remove Xijiao/Honghua, add Tiandong, Maidong, Huafen. Use pill for constipation. Regulated for 50 days; bleeding stopped. Relapsed after half a year.
Pan Biquan's daughter, 18, menstruation stopped abruptly after extreme grief/anger. Subsequently developed hematemesis (~1 bowl/time), afternoon tidal fever, anorexia, constipation. Treated with Xijiao Dihuang Tang, causing epigastric fullness, vomiting (phlegm/blood/sour fluid), chest/hypochondriac distension. Pulse: surging-large-wiry. Diagnosis: Blood stasis. Old stasis blocks new blood generation, causing erratic flow. Treatment: Unblock stasis to restore normal circulation. Run Zi pill + Taoren + Honghua pills, 3 doses/day. Interspersed with Tiaoqi Rongying Tang. Evacuated much stasis; fever subsided, menses resumed, hematemesis stopped.
Lu Zuyu treated a Mr. Yu, irritable/angry, sudden hematemesis (7-8 bowls), fever, dyspnea, abdominal distension, insomnia, anorexia. Self-medication with yin-nourishing/astringent herbs worsened condition. Pulse: six positions like striking stones, nearly 7 beats/cycle; Right Guan particularly forceful. Light touch on abdomen triggered blood spurting. Excess syndrome. Prescribed Xiao Xianxiong Tang (Minor Chest Trap Decoction) x2 doses + Iron Rust Water. Halved next day. Constipation for 7-8 days required purgation. Run Zi pill + Taoren pill, labeled "Stop Bleeding Pill". Nighttime evacuation of half bucket of blood/stool; hematemesis stopped immediately.
Wu Shizi, 16, hematemesis, sallow complexion, emaciation, diarrhea, limb edema, history of spermatorrhea (worsening). Pulse: six positions deficient-rapid. Cooling herbs reduced bleeding but increased fever, vomiting, edema, diarrhea. Fatal prognosis with cold-cooling approach. Prescription: Open stomach, warm middle, strengthen Spleen, nourish blood. Over one month: formed stools, resolved edema, fever subsided, appetite returned. Maintenance: Liuwei Dihuang Wan + Zhimu, Baihu, Duzhong, Gouqi, Muli, Maidong, taken at dawn. 50+ doses of decoction; fully recovered.
Prefect of Chuzhou reported: A clan sister, nun in Xingan temple, sudden massive hematemesis, chills/fever, suspected consumptive disease but undiagnosed. A scholar advised Huarui Shi San (Flower Ochre Stone Powder) mixed with child's urine. Recovered in days. Others found it effective. (Source: *Yishuo Xubian*.) Recipe: Huarui Shi 1 jin, high-quality Sulfur 4 liang. Mix, seal in clay, bake in earthenware jar until dry. For urgent use, bake in drying cabinet/charcoal. Grind finely with water next day. Dose: 1 qian, washed down with hot child's urine/wine. Also treats retained placenta, internal blood stasis, urinary/fecal obstruction. (Source: *Liangfang*.)
Yu Jiayan treated Huang Zhanhou, chronic hemorrhagic disease. Sudden massive hematemesis (basin of blood) in study. Throat congestion, mental drifting, high fever, stiff neck tendons. Pulse: Chi chaotic. Diagnosis: Severe sexual exhaustion the previous night. Blood color bright red like sunrise. Servant compared it to slaughterhouse blood. Yu noted: Shaoyin meridian connects to tongue base; Kidney blood surging out hardened the tongue. No emergency measure available except one: Pill to anchor Yuan Qi. If Qi returns to Dantian, hope remains. Decocted dense Ginseng soup to swallow 30 Black Tin Pills (Heixi Dan). Sound heard in throat, pill descended. Tongue softened, speech returned (hoarse). Urgent moistening/purgative needed. Prescription: Ejiao (Donkey-hide Gelatin) ~1 liang, melted, taken hot in 3 doses with hot water. Half-day course: fever subsided, neck stiffness resolved, ate congee. Kidney-nourishing herbs for 5 days: voice cleared, mind stabilized. Daily deep-red blood (~1 cup) persisted due to summer heat. Following *Neijing* principle "Heat forcing blood overflow treated with salty-cold," added Autumn Stone (Qiushi) to kidney tonics. Recovered.
Liu Yinzhi's eldest son: Hemorrhage recurring 2-3 times/year, increasing volume. Cough, fever, anorexia, emaciation. Summer/Autumn: chills/fever like malaria, lasting till dawn, resolving with slight sweat. Later, chills/fever decreased,转为 diarrhea. Ren Shen/Atractylodes caused chest oppression, throat blockage. Fuling, Yam, and refined Red Lead (Hongqian) powder evacuated liters of black blood clots; chest/throat relief, facial color improved. Father believed this was "bamboo broken, bamboo patched" (tonifying based on pathology). Added Gui/Zhi (Cinnamon/Aconite). Result: Diarrhea 10+ times/day, inability to eat, confusion. Pulse: Spleen large-floating; Kidney small-chaotic; Lung sinking-hidden. Diagnosis: Loss of Yin, aggravated by harsh warming drugs. Prognosis: Poor (death expected within 2 nights). Classics: Acute illness is not purely Yang; chronic illness is not purely Yin. Years of hemorrhage indicate Yang-excess/Yin-deficiency. Anorexia leads to blood deficiency, muscle wasting, blood drying. Deficiency increases, Excess (Fire) increases. Yin-fire flares, injuring Lung Metal. Cough/phlegm disrupts descending function. Kidney Water lacks Mother Qi (Metal), failing to nourish body. Emaciation. Chills at Shen/You hours (3-7 PM), turning to fever till dawn, resolving with sweat. Like summer heat requiring rain. Body has Spring/Summer but no Autumn/Winter. Treatment should cool Metal/Water to suppress fire. However, using Ren/Shen for diarrhea ignored extreme Lung heat. Heat must vent through skin. Tonification without dispersion moves heat to Large Intestine (becomes dysentery). Red Lead induced black blood evacuation because Yin-blood, trapped by membrane origin, was guided downward by menstrual-type blood action (sympathetic resonance). Temporary relief/improvement was due to purgation, not tonification. Pre-stocked Red Lead misled by alchemists as true Yang tonic. Gui/Zhi depleted Yin. Now Chi pulses chaotic (fire burning, spring dry), Spleen/Stomach floating (yin lost from diarrhea, Yang unattached), Lung hidden (Metal contracting). Spirit lost. Irreversible.
Zhang Jingyue treated Ni Xiaolian, 40+, chronic spleen injury from worry, vomiting on exertion, responsive to Liyin Jian/Wenwei Yin. Late summer, social fatigue injured Heart/Spleen. Upper hematemesis, lower hematochezia (large pieces, purple/red). Physicians attributed to Labor-Fire in Heart/Spleen + Summerheat. Prescribed Xijiao, Dihuang, Child's urine, Zhimu. Two doses worsened vomiting, pulse tight-rapid, critical state. Zhang diagnosed: Pulse/symptoms contradictory. Used Ren Shen, Shudi, Ganjiang, Gancao in large dose. First dose unchanged; second dose reduced vomiting, pulse showed life. Added Paogjiang, Fuzi each 2 qian; Ren Shen, Shudi each 1 liang; Baizhu 4 qian; Zhi Gancao 1 qian; Fuling 2 qian. Taken at dusk; slept deeply. Woke with bleeding/vomiting stopped. Warm-tonic regulation; recovered in 10 days. Analysis: Labor-fatigue injured Spleen, Qi-deficiency failed to control blood. Season was Fire, but syndrome was not Fire. Cold-cooling herbs caused Spleen failure/death. Similar cases (Shi et al.) saved with Liuwei Huiyang Yin. (Ye Tianshi critique: Vomiting requires Ren/Baizhu combination, not just Shudi/Ganjiang. Success likely due to accidental Baizhu inclusion. Vomiting is Spleen/Stomach disease; needs Baizhu/Fuling/Chenpi. Gui Pi/Si Jun/Liu Jun modifications are best. Liuwei Huiyang Yin is theoretical; "Labor" implies Fire, but requires gentle warming, not hot herbs. *Neijing*: "Labor requires warmth" means nurturing, not heating.)
Li Shicai treated Zhang Mingzhi, 2 years hematemesis, sallow, tidal fever, cough, slight chest pain, rapid-deep pulse, throbbing pain worse at night, unpressable. Diagnosis: Hard blood accumulation, requires strong purgation. Due to chronicity, avoided harsh purgatives. Used Yujin, Jiangzhen, Dang Gui, Sheng Di, Shan Jia, Peng Ru, Ren Shen. Evacuated lacquer-like blood several times; pain reduced. Recurred after month; disease heavy, medicine light. Used Dahuang, Ganqi, Peng Ru, Ren Shen. Recurred again. Final formula: Dahuang, Ganjiang, Peng Ru, Yujin, Shan Jia, Rougui, Dang Gui Wei, Taoren, Meng Chong as pills. Morning: Ren Shen decoction. Afternoon: Pill (1 qian). 10 days: Massive blood evacuation; stable. (From *Yifang*.)
Mr. Zhang's son: Hematemesis, fever, spermatorrhea, night sweats, emaciation. Previous doctor warned against Ren Shen ("fatal if taken"). Treatment failed. Li Shicai diagnosed: ...