从虚治，血脱益气之法也。今病逾两旬，不为暴矣，去血盈斗，不为少矣，而红尚未止者何也？良由失血既久，
阳虚无根据，如浪子迷途，不知返驾，若再从事清理，则虚火愈炽，血从何而归经？急须补养心脾，方可无虑。
勿以参为助火，而坐失机宜也。其后惑于他歧，终致不起。
聂久吾曰∶一友春间考试，多饮烧酒，咳嗽吐痰，每晨出痰血数十多口。求诊，已定方，虽用清凉，而制
炒又兼滋补。适一医至，见其火盛，用桃仁承气汤下之，又用凉药二剂，乃生芩、连、栀、柏之类。彼求速效，
欲用其方。有疑之者特问予。予曰∶骤下之若误，恐不可为。无已，姑用其凉汤试之，彼竟以二剂一日服之，
至夜分，咳嗽不止，吐红满地。于是用予方四十余剂，又每日用悉尼汁一瓯，顿温服，逾两旬，而咳与红悉愈
矣。夫清凉一也，或服之转剧，或服之而瘳何也？盖火性急疾，亟攻之则其势愈炎，缓治之则其邪渐息，此情
理之常，而庸庸者不知也。其方二冬、二母、栀、柏、芩、连、丹皮、生地、花粉、元参、前胡、桔梗、香附、
枳实、侧柏叶、生甘草，生姜一片，水一碗，煎入八分温服。（诸药炒制，亦与众同。）
魏玉横曰∶关太孺人，年七十七，久患胁痛，左半不能卧，食少不眠。十月间，忽吐血数口，进童便不应。
或与之小剂生地、山栀、茅根、茜草之类亦不应。或谓有瘀，用方与前相仿。诊之，右关弦略数，左右寸俱鼓
指，曰∶凡吐血属瘀者，多杂紫黑成块，今所去皆散漫不凝，盖由肝木失养，燥而生火，值亥月木生之时，不
能藏蛰，反腾而上，冲击胃络，致阳明之火，泛滥而出也。虽在寒月，必使加黄连于养荣之剂，以抑之使其下
降潜伏，自无痛沸之患矣。用生熟地、沙参、麦冬、山药、杞子，入连三分，酒炒焦，数服血止食进，又十剂
全愈。第此病属在年高病久，非大剂两仪膏，真元不易复元也。
徐宇治年未三十，先患舌疮，数年不愈，仲秋忽呕血，每日或一碗，或一杯，或十数口。脉之，两手皆豁
大，状如慈葱，重按则涩而略数。此木性久横，遇金旺之时，抑不得遂，故使胁痛而有块。其少腹之气，上冲
而作咳嗽咽痛者，龙雷挟火以仇金也。其手足常冷者，土受木侮而作厥也。究其根源，良由水不足，而又遇燥
令，非生金滋水，何以驯而扰之？生地、杞子、沙参、麦冬、元参、蒌仁，七八剂，脉渐敛，症渐瘳。又内熟
地一两，数剂并疮亦愈矣。
仆甘年未四十，虬然一胡，素有血症。立夏，忽吐血数盆，面色青惨，寒热往来，夜热尤甚，咳嗽连声，
而抬肩倚息，颠顶左半筋抽掣痛不可忍，此厥阴怒火上冲胃络也。胃为多气多血之府，且其人多胡，则血必多，
故暴去如许，而脉不躁大也。与生地、杞子各一两，沙参五钱，麦冬三钱，蒌仁二钱，数帖诸症悉愈。愈后，
面青不减，谓肝木久伤，宜多服前剂以滋养之，否则根 枯悴，无以发生也。不听，从至亥月，木生之后，病
果作。反谓前者服重补，将病补住，故复发。更医数人，至次年雨水而殁。
叶天士曰∶一人吐血，曰春温嗽痰，固属时邪，气质有浓薄，不可概以辛散，且在知识发动之年，阴分自
不足，以致咳呛吐血，当以甘寒润降以肃金。鲜枇杷叶、甜杏仁、南沙参、川贝母、甜水梨、甘蔗浆。徐灵胎曰∶
此为正治，此药最宜留心。
汪某年七十，天明至午，嗽甚痰血。春暖阳浮，是肾虚不能藏，咳音浊不爽。先议轻清治气分之热，桑叶、
花粉、黑栀皮、桔梗、甘草、橘红。
徐灵胎曰∶桔梗升提，凡咳症血症，非降纳不可。此品却与相反，用之无不受害。其故由于仲景治
少阴喉症用甘桔汤，遂以桔梗为清肺降火之品，不知仲景之方，乃专以甘草治少阴犯肺之火，恐甘草留入中
宫，不能留于上焦，故少用桔梗以载甘草，存留上焦。后人不知，竟以为咳嗽之要药，岂不大谬！故桔梗
同清火疏痰之药，犹无大害。若同辛燥等药用之，无不气逆痰升，涎潮血涌。余目视甚多，而药者无一人
能悟，自宋以来，无不尽然，不独今也。此老亦随俗不察耳。
一人脉特数，舌心灰，咳痰有血，频呕络伤，致血随热气上出，仍理气分，桑叶、花粉、苡仁、川贝母、
黄芩、茯苓。（徐灵胎曰∶咳而呕者，毋专治肺，当降纳胃气也。）
江某积瘀在络，动络血逆。今年六月初，时令暴热，热气吸入，首先犯肺，气热血涌。强降其血，血药皆
属呆滞，而清空热气，仍蒙蔽于头髓空灵之所，诸窍痹塞，鼻窒 肉，出入之气，都从口出。显然肺气郁蒸，
致脑髓热蒸，脂液自下。古称烁物消物莫如火，但清寒直泄中下，清空之病仍然。（名言。）议以气分轻扬，无
取外散，专治内通。（妙想。医工遇此法，则每每忽而失察。连翘、牛蒡子、通草、桑叶、鲜荷叶汁、青菊花叶，
临服入生石膏末，煎一沸。）
一人年二十三，以毒药熏疮，火气逼射肺金，遂咳呛痰血，咽干胸闷。诊脉尺浮，下焦阴气不藏，最虑病
延及下，即有虚损之患，姑以轻药，暂清上焦以解火气。杏仁三钱，绿豆皮三钱，冬瓜皮三钱，苡仁三钱，川
贝钱半，马兜铃七分。
严某年四十三，脉数涩小结，痰血经年屡发，仍能纳食应酬，此非精血损怯，由乎五志过动。相火内寄肝
胆，操持郁勃，皆令动灼，致络血上渗，混入痰火，必静养数月方安，否则木水劫灼，胃伤减食，病由是日加
矣。丹皮、薄荷梗、菊花叶、黑栀子、淡黄芩、生白芍、郁金、川贝母。
藜按∶此神志之病，固非药饵所能胜。然静以制动，润以滋液，亦用药之规则也，喻氏制滋液救焚汤以
治。夫关格之症，本无治法，喻氏之方，亦为徒设。窃拟借以治此症，颇为酌对。至方中之五味、人参，
则临症酌其去取可也。生地二钱取汁，麦冬二钱取汁，人参一钱五分，人参拌蒸炙甘草一钱，真阿胶一钱，
胡麻仁一钱炒研，柏子仁七分炒，五味子四分，紫石英一钱，寒水石一钱，滑石一钱，生犀角汁三分，姜
汁二茶匙。上除四汁及阿胶，用泉水四茶杯，缓煎至一杯半，去渣，入四汁及阿胶，再上火，略煎至胶烊
化，斟出，调牛黄细末五厘，日中分二三次热服。
叶天士曰∶凡咳血之脉，右坚者，又在气分，系震动胃络所致，宜薄味调养胃阴，生扁豆、茯神、北沙参、
苡仁等类。左坚者，乃肝肾阴伤所致，宜地黄、阿胶、枸杞、五味等类。脉弦胁痛者，宜苏子、桃仁、降香、
郁金等类。成盘碗者，葛可久花蕊石散，仲景大黄黄连泻心汤。一症而条分缕晰，此再加分别，则临症有据矣。
邹某年二十四，向有失血，是真阴不旺。夏至阴生，伏天阳越于表，阴伏于里，理宜然矣。无如心神易动，
暗吸肾阴，络脉聚血，阳触乃溢。阴伏不固，随阳奔腾，自述下有冲突逆气，血涌如泉。盖任脉为担任之职，
失其担任，冲阳上冲莫制，皆肾精肝血不主内守，阳翔为血溢，阳坠为阴遗，腰痛足胫畏冷，何一非精夺下损
现证？经言，精不足者，补之以味。药味宜取质静，填补重着归下。莫见血以投凉，莫因嗽以理肺。若此治法，
元海得以立基，冲阳不来犯上。然损非旬日可复，须寒暑更迁，凝然不动，自日逐安适，调摄未暇缕悉也。
人参三钱，熟地炒松成灰四钱，冷水洗一次，鲜河车膏一钱和服，茯苓钱半，炒黑枸杞子钱半，北五味一钱，
沙苑蒺藜一钱半，紫石英五钱生研。（徐灵胎曰∶以五味易牡蛎则无弊矣。）
蒋某年六十二，宿伤怒劳，血溢紫块，先以降气导血，苏子、降香末、桃仁、黑山栀、金钗石斛、制大黄。
徐灵胎曰∶叶氏治血病，其议论大端不信古，而用药全然不知其大犯在用麦冬、五味、玉竹、沙参。夫
麦冬乃补肺之重剂，肺气虚极，气不能续，则用之以补肺气，如麦门冬汤、竹叶石膏汤是也，盖防其窒
腻耳。若吐血咳嗽，乃肺家痰火盘踞之病，岂宜峻补，从此无愈日矣。至五味之酸，一味收敛，仲景用之
以治上气咳逆，肺脉不合之症，然必与干姜同用，以辛散寒邪，从无独用者。今吐血之嗽，火邪入肺，痰
凝血壅，惟恐其不散不降，乃反欲其痰火收住肺中，不放一毫去路，是何法也？其沙参、玉竹之补肺，大
略相近。呜呼，此之不明，后世永无吐血不死之人矣。举世尽然，今为尤甚，伤哉！又曰∶古时虚劳与吐
血，确是二病。虚劳是虚寒症，以温补为主。吐血之症不一，大约原阴虚火旺者为多。叶氏亦言之凿凿，
但有时仍以建中汤为治，则又误以仲景虚劳治法，混入吐血门中，终是胸无定见也。五十年前吐血者极少，
诸前辈无不以服补肺药为戒，所以死者绝少。目今吐血者十人而五，不服药者无不生，服麦冬、五味者
无不死。此虽时令使然，而药误亦不少也，可不畏哉。
《广笔记》曰∶今之疗吐血者，大患有二∶一则专用寒凉，如芩、连、山栀、知、柏之类，往往伤脾作泻，
以致不救。一则专用人参，肺热还伤肺，则咳嗽愈甚。亦有用参而愈者，此是气虚喘嗽，与阴虚火炽者不同，
然亦百不一二也。仲淳立论，专以白芍药，炙甘草制肝，枇杷叶、麦冬、薄荷叶、橘红、贝母清肺，薏苡仁、
淮山药养脾，韭菜、降香、苏子下气，青蒿、鳖甲、银柴胡、丹皮、地骨皮补阴清热，炒枣仁、白茯神、山萸
肉、枸杞补肾，屡试辄验。然阴无乍长之法，非多服不效。病家欲速其功，医者张皇无主，百药杂试，以致殒
身，覆辙相寻不悟，悲夫。（郁金治吐血圣药，患无真者耳。）
藜按∶所指二弊，极为明透。苦寒之弊，人皆知戒，无敢犯者。惟温补一途，凡以名医自负，及古今方
书，无不以此为主，杀人无算，毫不知悟。偶遇阳虚之疾，治以温补而愈，遂认影作身，列为医案，哓哓
辨论，以为治血症之法，理应如此，不知血症之能服参、 者，愈之甚易，殊不劳先生之畅发高论也。论
中所列药品，亦极平稳，惟韭菜、山萸、枸杞，尚宜斟酌用之。
张飞畴治邹孔昭昆仲，俱患喘咳吐血，肩息不得卧。孔昭之脉，尺部虽弦，而寸关却和平，此火迫肺脉，
又兼感客邪。审其所吐之血，多带痰水，知必从胃而出。先与小建中加丹皮和其荣卫，续与异功去术，加山药、
丹皮、灵砂丹，收摄泛火，则肺胃自清，遂愈。千昭之脉，关尺皆弦细，如循刀刃，血色正赤如凝朱，为少阴
守藏之血，辞不治。又治费仲雪，久患膈塞呕逆，中脘觉痛如刺，不时痰中带血，六脉沉细如丝。自谓六阴之
脉，及按至神门，别有一脉，上至阳溪，迢迢应指，知胃气未竭，尚可久延。其女不过咳血一二次，尚能梳洗
出入，诊得纯弦细数，此胃气已竭，安有复生之理？亦辞不治。
藜按∶观此数案，知诸公于阴虚火炎之虚劳，皆弃之不治。而其所谓用建中、异功及归、 、麦、术等
药而愈者，皆阳虚之症，而非阴亏火炎之症也。遍览方书，所列虚劳诸治法，未尝不灿然可观，于阴虚火
炎之症，亦未尝混同立论，而其究必归于补阳，盖未尝于此中身亲阅历，故所谈皆捕风捉影也。以余所见，
阴虚火炎之症，其脉无不细数而弦，皆医者医书所谓不治之症，然调治得宜，亦有愈者。其治法大约以脾
胃为主，而难处在不能用参、术，故非积以岁月不可。迨至阴气渐回，弦细之脉渐减，可用参、术大补时，
而其病已愈矣。
徐灵胎曰∶五十年前，吐血者绝少，今则年多一年，其证本皆可愈，而多不治者，药误之也。盖血证因伤
风咳嗽而起者，十之七八，因虚劳伤损者，十之二三。乃医者概以熟地、人参、麦冬、五味等滋补酸敛之药，
将风痰瘀俱收拾肺管，令其咳嗽不止，元气震动，津液化痰，不死何待？凡风寒补住，必成劳病，无人不知，
今竟无一人知之矣。盖吐血而嗽者，当清肺降气，略佐补阴之品。其不嗽者，乃喉中之络破，故血从络出，并
不必服药。其甚者，只取补络之药以填损处，自可除根，即不服药，亦能自愈，历试不爽。但病者进以不服药
之说，则虽或面从，背后必非笑随之。进以熟地、麦冬、人参、五味等药，则甘心就死。前者死矣，后者复然，
岂非命乎。
黄锦芳治刘某，咳血有年，时发时止。审其血，虽色红不黑，而半杂白饮；望其色，虽红而不白，而却倏
忽不定；察其气息，虽奔迫上急，但静坐则平，动作则剧；听其声音，则暴迫不响；询其饮食，则阴润之物，
不敢习进。先服之药，类多清润，初服似效，再服即觉不宜。偶服柿饼，遂觉冷气沁心。诊其脉，左右二关俱
弦数击指，而却无力。用苡仁三钱，麦冬五分，下气为君；龙骨、首乌、阿胶各一钱，养肝为臣。牛膝钱半，
引气及血归左；附子五分，五味子五粒，引火及气归右。用浓朴、广皮以除脾胃痰湿。服二剂，气平大半，左
关数脉亦减。但脾肺脉仍鼓指未平，是肺之寒，脾之湿，尚未除也。去五味、麦冬，加广皮、浓朴以疏脾，
从虚证论治，这是“血脱益气”的治疗方法。如今患病已超过二十天，不算突发急症了；失血量达到一斗以上，也不算少了，但出血仍未停止，为什么呢？大概是因为失血时间长久，阳气虚弱而无依附，就像浪子迷失方向，不知道返回驾车（回家），如果再用清利攻伐的方法治疗，那么虚火会更加旺盛，血液从哪里回归经脉呢？必须紧急补养心脾，才可以没有后顾之忧。不要认为人参会助长火势，而错失治疗良机。后来患者听信其他医生的建议，最终导致死亡。
聂久吾说：有一位朋友在春季参加科举考试，大量饮用烧酒，出现咳嗽吐痰的症状，每天早晨咳出带血的痰液几十口。求诊时，我已经定好方子，虽然用了清凉药物，但也兼顾了炒制和滋补。恰好一位医生到来，看到患者火气旺盛，便使用桃仁承气汤进行泻下，又用了两剂凉药，主要是黄芩、黄连、栀子、黄柏之类。患者追求速效，想用这位医生的方子。有人对此表示怀疑，特意来问我。我说：“突然使用泻下法如果误治，恐怕后果不堪设想。如果不行，暂且试用他的凉药吧。”结果患者竟然在一天之内服完了两剂药，到了半夜，咳嗽不止，吐血满地。于是使用了我的方子四十多剂，又每天用雪梨汁一杯，加热后顿服，过了二十多天，咳嗽和吐血都痊愈了。同样是清凉药，有的服用后病情加重，有的服用后痊愈，为什么呢？因为火性急迫猛烈，急切地攻伐它，它的势头反而更旺；缓慢地治疗它，邪气才会逐渐消退。这是常理，但平庸的医生不懂这个道理。我的方子包括：天冬、麦冬、知母、贝母、栀子、黄柏、黄芩、黄连、牡丹皮、生地黄、天花粉、玄参、前胡、桔梗、香附、枳实、侧柏叶、生甘草，加生姜一片，水一碗，煎至八分，温服。（所有药物都经过炒制，与其他医生相同。）
魏玉横说：关太孺人，七十七岁，长期患有胁痛，左侧身体无法躺卧，食欲少，睡眠差。十月间，忽然吐血几口，服用童便无效。有人给她用小剂量的生地黄、山栀、白茅根、茜草等药，也不见效。有人说有瘀血，用的方子与前面相似。诊脉发现，右关脉弦略数，左右寸脉均鼓指有力。我说：“凡是因瘀血导致的吐血，大多夹杂紫黑色成块的血液，现在排出的都是散漫不凝固的血，这是由于肝木失去滋养，干燥而生火，正值亥月（冬季）木气生长之时，不能潜藏蛰伏，反而升腾向上，冲击胃络，导致阳明之火泛滥而出。虽然在寒冷的月份，也必须在养荣的药剂中加入黄连，以抑制火势使其下降潜伏，自然就不会有疼痛沸腾的祸患了。”于是使用生地黄、熟地黄、沙参、麦冬、山药、枸杞子，加入三分黄连（酒炒焦），服用几剂后血止食进，又服十剂完全痊愈。只是这个病属于年老病久，如果不是大剂量的两仪膏，真元不容易恢复。
徐宇治，年龄不到三十岁，先前患舌疮，几年不愈，仲秋时节忽然呕血，每天或一碗，或一杯，或十几口。诊脉，两手脉象皆豁大，形状像慈葱（中空），重按时则涩而略数。这是肝木之气长期横逆，遇到金气旺盛的时候（秋季），被抑制而不能舒展，所以导致胁痛且有肿块。其少腹之气上冲而引发咳嗽咽痛的，是龙雷之火挟带火热来对抗金气。其手足经常发冷的，是土受木侮而导致的厥冷。究其根源，确实是由于肾水不足，而又遇到燥令，不是通过生金滋水的方法，怎么能驯服并安抚它呢？使用生地黄、枸杞子、沙参、麦冬、玄参、瓜蒌仁，七八剂后，脉象逐渐收敛，症状逐渐减轻。又加入熟地黄一两，服用几剂后，疮疡也痊愈了。
仆人甘某，年龄不到四十岁，胡须浓密，素有血症。立夏时节，忽然吐血数盆，面色青惨，寒热往来，夜间发热尤其严重，连续咳嗽，抬肩呼吸，头顶左侧筋脉抽掣疼痛难忍，这是厥阴怒火上冲胃络。胃是多气多血的脏腑，而且此人胡须浓密，说明血气必盛，所以暴发性失血如此之多，但脉象并不躁动盛大。给予生地黄、枸杞子各一两，沙参五钱，麦冬三钱，瓜蒌仁二钱，服用几帖后各种症状全部痊愈。痊愈后，面色依然发青，说是肝木长期受损，应该多服用前面的药剂来滋养，否则根基枯悴，无法发生生机。他不听劝告，直到亥月，木气生长之后，疾病果然复发。他反而认为之前服用重补的药物，将病邪补住了，所以复发。更换了几个医生，到次年雨水节气时去世。
叶天士说：一人吐血，说是春温引起的咳嗽痰多，这固然属于时邪，但人的体质有浓薄之分，不能一概用辛散之法，况且此人在知识发动之年（青春期），阴分本来就不足，以致于咳呛吐血，应当用甘寒润降的方法来肃清肺气。处方：鲜枇杷叶、甜杏仁、南沙参、川贝母、甜水梨、甘蔗浆。徐灵胎说：这是正治之法，这些药最值得留心。
汪某，七十岁，从天明到中午，咳嗽厉害，痰中带血。春暖时节阳气浮越，这是肾虚不能潜藏，咳嗽声音浑浊不畅。先议定用轻清之品治疗气分之热，处方：桑叶、花粉、黑栀子皮、桔梗、甘草、橘红。
徐灵胎说：桔梗具有升提作用，凡是咳嗽病症和血症，非降纳不可。桔梗与此相反，使用它没有不受害的。其原因在于张仲景治疗少阴喉症时使用甘桔汤，于是人们就把桔梗当作清肺降火的药物，不知道仲景的方子，是专门用甘草来治疗少阴犯肺之火，担心甘草留在中焦，不能停留在上焦，所以少量使用桔梗来承载甘草，使其存留于上焦。后人不知道这一点，竟把桔梗当作咳嗽的要药，难道不是大错特错吗！所以桔梗同清火疏痰的药一起用，还没有太大害处。如果同辛燥等药一起用，没有不导致气逆痰升、涎潮血涌的。我亲眼见过很多例子，而医生没有一个能领悟，自宋代以来，无不如此，不只是现在这样。这位老先生也是随波逐流不加考察罢了。
一人脉象特别快，舌中心灰暗，咳痰带血，频繁呕吐导致络脉损伤，致使血液随着热气上出，仍然调理气分，处方：桑叶、花粉、薏苡仁、川贝母、黄芩、茯苓。（徐灵胎说：咳嗽兼呕吐的，不要只治肺，应当降纳胃气。）
江某积瘀在络脉，动络导致血逆。今年六月初，时令暴热，热气吸入，首先侵犯肺脏，气热血涌。强行降血，血药都属于呆滞之物，而清空的热气，仍然蒙蔽在头髓空灵之处，诸窍闭塞，鼻塞肉腐，出入的气，都从口出。显然是肺气郁蒸，导致脑髓热蒸，脂液自行流出。古人称熔化物体、消蚀物体没有比火更厉害的，但如果只用寒凉直泄中下焦，清空部位的病仍然无法治愈。（名言。）议定用气分轻扬之药，不求外散，专治内通。（妙想。医工遇到这种方法，往往忽视失察。处方：连翘、牛蒡子、通草、桑叶、鲜荷叶汁、青菊花叶，临服时加入生石膏末，煎一沸。）
一人二十三岁，用毒药熏治疮疡，火气逼迫肺金，于是咳呛痰血，咽干胸闷。诊脉尺部浮，下焦阴气不藏，最担心病延及下部，即有虚损的祸患，暂且用轻药，暂时清解上焦以解火气。处方：杏仁三钱，绿豆皮三钱，冬瓜皮三钱，薏苡仁三钱，川贝母半钱，马兜铃七分。
严某，四十三岁，脉数涩小结，痰血经年屡次发作，仍能进食应酬，这不是精血亏损怯弱，而是由于五志过动。相火内寄于肝胆，操持劳碌、抑郁勃发，都会导致动火灼伤，致使络血上渗，混入痰火，必须静养几个月才能安宁，否则木水劫灼，胃受伤减少饮食，病情由此日益加重。处方：丹皮、薄荷梗、菊花叶、黑栀子、淡黄芩、生白芍、郁金、川贝母。
藜按：这是神志方面的病，固然不是药物所能胜任的。然而以静制动，以润滋液，也是用药的规则。喻氏制作滋液救焚汤来治疗。夫关格之症，本来没有治疗方法，喻氏的方子，也是徒设。我私下拟借用来治疗此症，颇为恰当。至于方中的五味子、人参，则临症酌情去掉或保留即可。处方：生地黄二钱取汁，麦冬二钱取汁，人参一钱五分，人参拌蒸炙甘草一钱，真阿胶一钱，胡麻仁一钱炒研，柏子仁七分炒，五味子四分，紫石英一钱，寒水石一钱，滑石一钱，生犀角汁三分，姜汁二茶匙。上面除四种汁及阿胶外，用泉水四茶杯，慢煎至一杯半，去渣，加入四种汁及阿胶，再上火，稍微煎至胶融化，斟出，调牛黄细末五厘，日中分二三次热服。
叶天士说：凡是咳血的脉象，右脉坚硬的，又在气分，是震动胃络所致，宜用薄味调养胃阴，如生扁豆、茯神、北沙参、薏苡仁等类。左脉坚硬的，乃肝肾阴伤所致，宜用地黄、阿胶、枸杞、五味子等类。脉弦且胁痛的，宜用苏子、桃仁、降香、郁金等类。吐出成盘碗状的，用葛可久的花蕊石散，张仲景的大黄黄连泻心汤。一个病症而条理分明，这里再加分别，那么临症就有依据了。
邹某，二十四岁，向来有失血病史，这是真阴不旺盛。夏至阴气始生，伏天阳气浮越于体表，阴气潜伏于里，按理应该是这样的。无奈心神容易动摇，暗中消耗肾阴，络脉聚血，阳气触动乃溢出。阴气潜伏不固，随阳气奔腾，自述下有冲突逆气，血涌如泉。任脉担任统摄之职，失去其担任功能，冲阳之气上冲无法控制，都是肾精肝血不能主司内守，阳翔导致血溢，阳坠导致阴遗，腰痛足胫畏冷，哪一个不是精夺下损的现实表现？经文说，精不足的，用厚味来补。药味宜取质地静止，填补重着归下。不要见血就用凉药，不要因为咳嗽就理肺。如果这样治疗，元海得以建立基础，冲阳不来犯上。然而亏损不是一两天可以恢复的，须经历寒暑更替，凝然不动，自然一天天安适，调摄来不及详细叙述。处方：人参三钱，熟地黄炒松成灰四钱，冷水洗一次，鲜河车膏一钱和服，茯苓半钱，炒黑枸杞子半钱，北五味子一钱，沙苑蒺藜一钱半，紫石英五钱生研。（徐灵胎说：用五味子代替牡蛎就没有弊病了。）
蒋某，六十二岁，宿伤怒气和劳累，血溢呈紫色块状，先用降气导血法，处方：苏子、降香末、桃仁、黑山栀、金钗石斛、制大黄。
徐灵胎说：叶氏治疗血病，其议论大体不信古，而用药全然不知其大犯在用麦冬、五味子、玉竹、沙参。麦冬是补肺的重剂，肺气虚极，气不能续，才用它来补肺气，如麦门冬汤、竹叶石膏汤就是，大概是防止其窒腻罢了。如果是吐血咳嗽，乃是肺家痰火盘踞的病，岂宜峻补，从此就没有痊愈的日子了。至于五味子的酸味，一味收敛，张仲景用它来治上气咳逆，肺脉不合的症候，但必须与干姜同用，以辛散寒邪，从未单独使用。现在吐血的咳嗽，火邪入肺，痰凝血壅，惟恐其不散不降，反而想让痰火收住肺中，不放一毫出路，这是什么办法呢？其沙参、玉竹补肺，大致相近。呜呼，不明白这一点，后世永远不会有吐血不死的人了。举世皆然，现在尤其严重，可悲啊！又说：古时候虚劳与吐血，确实是两种病。虚劳是虚寒症，以温补为主。吐血的症候不一，大约原阴虚火旺者为多。叶氏也说得很清楚，但有时仍以建中汤为治，则是又误把张仲景虚劳治法，混入吐血门中，终究是胸无定见。五十年前吐血者极少，各位前辈无不以服用补肺药为戒，所以死者绝少。目今吐血者十人中有五个，不服药的无不生还，服麦冬、五味子的无不死亡。这虽然是时令使然，而药物误治也不少，能不畏惧吗。
《广笔记》说：现在治疗吐血的人，大患有二：一则专用寒凉，如黄芩、黄连、山栀、知母、黄柏之类，往往伤脾导致腹泻，以致无法救治。一则专用人参，肺热还伤肺，则咳嗽更严重。也有用人参而痊愈的，这是气虚喘嗽，与阴虚火炽者不同，但也百无一二。仲淳立论，专用白芍药、炙甘草制约肝木，枇杷叶、麦冬、薄荷叶、橘红、贝母清肺，薏苡仁、淮山药养脾，韭菜、降香、苏子下气，青蒿、鳖甲、银柴胡、丹皮、地骨皮补阴清热，炒枣仁、白茯神、山萸肉、枸杞补肾，屡试辄验。然而阴气没有突然生长的方法，不多服不生效。病家想快速见效，医者慌张无主，百药杂试，以致丧命，覆辙相寻不悟，可悲啊。（郁金是治疗吐血的圣药，患的是假药罢了。）
藜按：所指的两个弊端，极为明透。苦寒的弊端，人都知道警惕，不敢犯。只有温补这一条路，凡是以名医自负，以及古今方书，无不以此为主，杀人无数，毫不觉悟。偶尔遇到阳虚的疾病，用温补治疗而痊愈，就认影作身，列为医案，哓哓辩论，认为治疗血症的方法，理应如此，不知道血症中能服用人参、黄芪的，痊愈很容易，根本不需要先生畅发高论。论中所列药品，也极平稳，只有韭菜、山萸、枸杞，尚宜斟酌使用。
张飞畴治疗邹孔昭兄弟俩，都患喘咳吐血，抬肩呼吸不能躺卧。孔昭的脉，尺部虽弦，但寸关却和平，这是火迫肺脉，又兼感客邪。审察他所吐的血，多带痰水，知道必定从胃而出。先与小建中汤加丹皮调和荣卫，随后与异功散去白术，加山药、丹皮、灵砂丹，收摄泛火，则肺胃自然清净，于是痊愈。千昭的脉，关尺皆弦细，如循刀刃，血色正赤如凝朱，为少阴守藏之血，推辞不治。又治疗费仲雪，长期患膈塞呕逆，中脘觉痛如刺，不时痰中带血，六脉沉细如丝。自称是六阴之脉，及按至神门穴，别有一脉，上至阳溪穴，迢迢应指，知道胃气未竭，还可以久延。他的女儿不过咳血一两次，尚能梳洗出入，诊得纯弦细数，这是胃气已竭，哪有复生的道理？也推辞不治。
藜按：看这几个案例，知道各位先生对于阴虚火炎之虚劳，都弃之不治。而他们所谓用建中汤、异功散及当归、黄芪、麦冬、白术等药而痊愈的，都是阳虚之症，而非阴亏火炎之症。遍览方书，所列虚劳诸治法，未尝不灿然可观，对于阴虚火炎之症，也未尝混同立论，但其最终必然归于补阳，大概是因为未曾在此中亲身阅历，所以所谈皆是捕风捉影。以我所见，阴虚火炎之症，其脉无不细数而弦，都是医者医书所谓不治之症，然而调治得宜，也有痊愈的。其治法大约以脾胃为主，而难处在不能用参、术，所以非积累岁月不可。等到阴气渐回，弦细之脉渐减，可用参、术大补时，而其病已经痊愈了。
徐灵胎说：五十年前，吐血者绝少，现在则一年多一年，其证本皆可愈，而多不治者，是药物误治造成的。大概血证因伤风咳嗽而起者，十之七八，因虚劳伤损者，十之二三。乃医者一概用熟地黄、人参、麦冬、五味子等滋补酸敛之药，将风痰瘀都收拾在肺管，令其咳嗽不止，元气震动，津液化痰，不死何待？凡是风寒补住，必成劳病，无人不知，现在竟无一人知道了。大概吐血而嗽者，当清肺降气，略佐补阴之品。其不嗽者，乃是喉中之络破，故血从络出，并不必服药。其甚者，只取补络之药以填损处，自然可以除根，即使不服药，也能自愈，历试不爽。但病者进言不服药之说，则虽然表面顺从，背后必非笑随之。进言用熟地黄、麦冬、人参、五味子等药，则甘心就死。前者死了，后者又这样，岂不是命运吗。
黄锦芳治疗刘某，咳血多年，时发时止。审察其血，虽然色红不黑，但半杂白饮；望其面色，虽然红而不白，却忽明忽暗不定；察其气息，虽然奔迫上急，但静坐则平，动作则剧；听其声音，则暴迫不响；询问其饮食，则阴润之物，不敢习进。先前服用的药，类多清润，初服似有效，再服即觉不宜。偶服柿饼，遂觉冷气沁心。诊其脉，左右二关俱弦数击指，却无力。用薏苡仁三钱，麦冬五分，以下气为君药；龙骨、首乌、阿胶各一钱，以养肝为臣药。牛膝半钱，引气及血归左；附子五分，五味子五粒，引火及气归右。用厚朴、广皮以除脾胃痰湿。服用两剂，气平大半，左关数脉亦减。但脾肺脉仍鼓指未平，是肺之寒，脾之湿，尚未除去。去掉五味子、麦冬，加广皮、厚朴以疏脾，
Treating from deficiency is the method of "benefiting Qi when blood is lost." Now, the illness has lasted for more than twenty days, so it is not an acute onset; the blood loss amounts to a *dou* (a large unit of volume), which is not little, yet the red blood has not stopped. Why? It is likely that due to prolonged blood loss, Yang Qi is deficient and lacks a foundation, like a prodigal son who has lost his way and does not know how to return. If one continues with clearing and purging methods, the deficient fire will become even more intense, and from where can the blood return to its vessels? Urgent supplementation and nourishment of the Heart and Spleen are required to avoid further worry. Do not consider Ginseng as aiding fire, thereby missing the opportunity for treatment. Later, influenced by other doctors, he ultimately died.
Nie Jiuwu said: A friend of mine took part in imperial examinations in spring, drank a lot of distilled liquor, and suffered from coughing and expectoration, bringing up dozens of mouthfuls of bloody sputum every morning. Upon consultation, I had already prescribed a formula. Although it used cooling herbs, it also incorporated stir-frying and tonifying methods. Just then, another doctor arrived, saw the patient's excessive fire, and used Tao Ren Cheng Qi Tang (Peach Kernel and Rhubarb Decoction) to purge, followed by two doses of cold medicines, mainly Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Zhi Zi (Gardeniae Fructus), and Huang Bai (Phellodendri Cortex). The patient sought quick results and wanted to use this doctor's prescription. Someone doubted it and asked me specifically. I said, "Sudden purging if done incorrectly may lead to irreparable consequences. If necessary, try his cooling decoction tentatively." He actually consumed both doses in one day. By midnight, the coughing did not stop, and blood filled the floor. Then I used my prescription for over forty doses, and daily administered one cup of Xi Li Zhi (Snow Pear Juice), taken warm in one gulp. After more than twenty days, both the cough and hematemesis were cured. Both are cooling herbs, yet some worsened the condition while others cured it. Why? Fire nature is urgent and fierce; attacking it urgently makes its momentum fiercer, while treating it slowly allows the pathogen to gradually subside. This is the normal principle, but mediocre doctors do not understand it. My formula included Dong Tian Hua Fen (Asparagi Radix), Dong Mu Gen (Bletillae Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Bei Mu (Fritillariae Bulbus), Zhi Zi, Huang Bai, Huang Qin, Huang Lian, Mu Dan Pi (Moutan Cortex), Sheng Di Huang (Rehmanniae Radix), Hua Fen (Trichosanthis Radix), Yuan Shen (Scrophulariae Radix), Qian Hu (Peucedani Radix), Jie Geng (Platycodonis Radix), Xiang Fu (Cyperi Rhizoma), Zhi Shi (Aurantii Fructus Immaturus), Ce Bai Ye (Biota Top Leaf), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma), plus one slice of Sheng Jiang (Zingiberis Rhizoma Recens). One bowl of water was decocted to eight-tenths, taken warm. (All herbs were stir-fried, same as others.)
Wei Yuheng said: Lady Guan, aged seventy-seven, suffered from long-term hypochondriac pain, unable to lie on her left side, with poor appetite and insomnia. In October, she suddenly vomited several mouthfuls of blood. Tong Bian (Child's Urine) was ineffective. Some prescribed small doses of Sheng Di Huang, Shan Zhi (Gardeniae Fructus), Mao Gen (Imperatae Rhizoma), and Qian Cao (Rubiae Radix), which were also ineffective. Someone suggested blood stasis and used a similar formula. Pulse diagnosis revealed a slightly rapid string-like pulse at the Right Guan position, and pulsating pulses at both Cun positions. I said: "In cases of hematemesis due to blood stasis, the blood is often mixed with dark purple clots. Here, the discharged blood is scattered and uncoagulated, caused by Liver Wood losing nourishment, drying out and generating fire. At the time of Hai month (Winter), when Wood energy grows, it fails to store and hibernate, instead rising upward, impacting the Stomach collaterals, causing Yangming fire to flood out. Even in cold months, one must add Huang Lian to Ying Rong (Nourishing Blood/Qi) formulas to suppress it, making it descend and hide, thus avoiding painful boiling complications." Using Sheng Di Huang, Shu Di Huang (Prepared Rehmanniae Radix), Sha Shen (Glehniae Radix), Mai Dong (Ophiopogonis Tuber), Shan Yao (Dioscoreae Rhizoma), and Qi Zi (Lycii Fructus), adding three fen of Huang Lian (wine-fried until charred), the bleeding stopped and appetite improved after a few doses. After ten more doses, she was fully recovered. However, given her advanced age and chronic illness, without large doses of Liang Yi Gao (Two-Yi Paste), the True Yuan would be difficult to restore.
Xu Yuzhi, under thirty years old, previously suffered from tongue ulcers that did not heal for years. In mid-autumn, he suddenly vomited blood, ranging from one bowl to one cup or a dozen mouthfuls daily. Pulse diagnosis showed both hands' pulses were hollow and large, resembling the慈葱 (Ci Cong, a type of green onion/scallion), slippery and slightly rapid upon heavy pressure. This indicates Liver Wood qi has been rampant for a long time. Encountering strong Metal qi (Autumn), it was suppressed and could not flow freely, causing hypochondriac pain and masses. The qi from the lower abdomen rushing upward causing cough and sore throat is Long Lei (Dragon Thunder) fire clashing with Metal. Cold hands and feet result from Earth being insulted by Wood, leading to Jue (cold extremities). The root cause is insufficient Water, compounded by dryness. Without generating Metal and nourishing Water, how can it be tamed? Using Sheng Di Huang, Qi Zi, Sha Shen, Mai Dong, Yuan Shen, and Lou Ren (Trichosanthis Semen), after seven to eight doses, the pulse gradually converged, and symptoms alleviated. Adding one liang of Shu Di Huang, after a few doses, the ulcers also healed.
Servant Gan, under forty, with thick beard, had a history of blood disease. At Lixia (Start of Summer), he suddenly vomited several basins of blood, with a blue-green pallid complexion, alternating chills and fever, worse at night, continuous coughing, shoulder-lifting breathing, and unbearable twitching pain in the tendons of the top-left head. This is Jueyin furious fire rushing up to the Stomach collaterals. The Stomach is the residence of abundant Qi and Blood, and since he has a thick beard, his blood must be abundant. Thus, despite massive sudden blood loss, the pulse is not rapid and large. Prescribed Sheng Di Huang and Qi Zi each one liang, Sha Shen five qian, Mai Dong three qian, Lou Ren two qian. After a few doses, all symptoms resolved. Post-recovery, the face remained blue, indicating long-term Liver Wood injury; continued nourishment was advised to prevent root withering. He refused, and after Hai month, when Wood energy grows, the disease relapsed. He blamed the previous heavy tonification for trapping the pathogen. Several doctors were consulted, and he died at Yushui (Rain Water solar term) the following year.
Ye Tianshi said: A patient with hematemesis attributed to Spring Warmth causing cough and phlegm. While this belongs to seasonal pathogens, constitution varies (thick vs. thin); one cannot generally use acrid-dispersing methods. Especially in the years of knowledge awakening (puberty), Yin deficiency is inherent, leading to coughing and hematemesis. One should use sweet-cold moistening and descending methods to肃 Jin (clear Lung metal). Prescription: Fresh Pi Pa Ye (Loquat Leaf), Tian Xing Ren (Sweet Almond Seed), Nan Sha Shen (Glehniae Radix), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), Tian Shui Li (Sweet Water Pear), Gan Zhe Jiang (Sugarcane Juice). Xu Lingtai said: This is the correct treatment; these herbs deserve attention.
Wang, aged seventy, experienced severe coughing with bloody sputum from dawn to noon. In warm spring, Yang floats; this is Kidney deficiency failing to store, resulting in turbid and unclear cough sounds. Initially, light-clearing herbs for Qi-level heat were proposed: Sang Ye (Morfolii Folium), Hua Fen, Hei Zhi Pi (Black Gardeniae Pericarpium), Jie Geng, Gan Cao, Ju Hong (Citri Reticulatae Pericarpium).
Xu Lingtai said: Jie Geng has ascending properties. For cough and blood diseases, descending and gathering are essential. Jie Geng opposes this; using it causes harm. The reason lies in Zhang Zhongjing's use of Gan Jie Tang (Licorice and Platycodon Decoction) for Shaoyin throat conditions. People mistakenly view Jie Geng as a lung-cooling herb. Zhongjing used it sparingly to carry Gan Cao to the Upper Jiao, preventing Gan Cao from staying in the Middle Jiao. Later generations misunderstood, making Jie Geng a key cough herb, which is a great error! Combined with clearing-fire and resolving-phlegm herbs, it is harmless. But combined with acrid-dry herbs, it invariably causes Qi rebellion, phlegm rising, saliva flooding, and blood gushing. I have seen many cases; no doctor realized this since the Song Dynasty. This elder also followed customs without scrutiny.
Another patient had a particularly rapid pulse, gray center of the tongue, coughing bloody sputum, frequent vomiting damaging collaterals, causing blood to rise with hot qi. Still regulating Qi level: Sang Ye, Hua Fen, Yi Yi Ren (Coicis Semen), Chuan Bei Mu, Huang Qin, Fu Ling (Poria). (Xu Lingtai said: For cough with vomiting, do not treat only the Lung; descend and gather Stomach Qi.)
Jiang had accumulated stasis in collaterals, causing collateral movement and blood reversal. In early June, extreme heat entered via inhalation, first attacking the Lung, causing Qi heat and blood surging. Strongly descending blood is ineffective as blood herbs are stagnant. Clearing empty heat still obscures the head marrow. Orifices block; nasal passages rot; breath exits only through the mouth. Clearly, Lung Qi stagnation steams brain marrow, causing lipid fluid to drip down. As ancients said, nothing melts or consumes like fire. Direct cold-draining of Middle/Lower Jiao fails to clear the Empty/Clear部位. Proposed using light-yielding Qi-level herbs, not for external dispersion, but internal passage. (Brilliant idea. Doctors often miss this.) Prescription: Lian Qiao (Forsythiae Fructus), Niu Bang Zi (Arctii Fructus), Tong Cao (Tetrapanacis Medulla), Sang Ye, Xian He Ye Zhi (Fresh Lotus Leaf Juice), Qing Ju Hua Ye (Green Chrysanthemum Leaf), with Sheng Shi Gao (Gypsum Fibrosum) powder added before serving, boiled briefly.
A twenty-three-year-old used toxic drugs to fumigate sores. Fire forced into Lung Metal caused coughing bloody sputum, dry throat, chest tightness. Pulse at Chi position floating; Lower Jiao Yin fails to store. Fear of progression to deficiency. Temporarily use light herbs to clear Upper Jiao and resolve fire. Prescription: Xing Ren (Prunus Semen) three qian, Lv Dou Pi (Vigna Radiata Testa) three qian, Dong Gua Pi (Benincasae Exocarpium) three qian, Yi Yi Ren three qian, Chuan Bei Mu half qian, Ma Dou Ling (Aristolochiae Fructus) seven fen.
Yan, forty-three, pulse rapid, choppy, small, and intermittent. Bloody sputum recurred annually for years, yet appetite and social activities remained normal. This is not Essence-Blood deficiency weakness, but excessive movement of Five Emotions. Ministerial Fire resides in Liver/Gallbladder; stress and depression cause fire agitation, damaging collaterals, mixing blood with phlegm-fire. Months of rest are needed; otherwise, Wood/Water depletion injures Stomach, reducing food intake, worsening the disease. Prescription: Dan Pi (Moutan Cortex), Bo He Geng (Menthae Herba Caulis), Ju Hua Ye (Chrysanthemum Leaf), Hei Zhi Zi (Black Gardeniae Fructus), Dan Huang Qin (Light Scutellariae Radix), Sheng Bai Shao (White Peony Root), Yu Jin (Curcumae Radix), Chuan Bei Mu.
Li An: This is a disorder of Spirit/Mind, not easily cured by herbs. Yet, stillness controls movement, moistening nourishes fluids—these are rules of medication. Yu Shi created Zi Ye Jiu Fen Tang (Moisturizing Fluid Rescue Burning Decoction) for this. Guan Ge syndrome has no cure; Yu Shi's formula is theoretical. I borrow it for this case, quite appropriate. Remove/adjust Wu Wei Zi and Ren Shen based on symptoms. Prescription: Sheng Di Huang juice, Mai Dong juice, Ren Shen, Gan Cao (steamed with Ren Shen), E Jiao (Donkey-hide Gelatin), Hu Ma Ren (Sesami Semen), Bai Zi Ren (Biota Seed), Wu Wei Zi, Zi Shi Ying (Hematitum), Han Shui Shi (Halloysitum), Hua Shi (Talcum), Sheng Xi Jiao (Rhinocerotis Cornu - substitute available), Jiang Zhi (Ginger Juice). Decoct spring water, filter, add juices and melted E Jiao, boil slightly, mix with Niu Huang (Calculus Bovis), take warm twice or thrice daily.
Ye Tianshi said: For hemoptysis pulses: Right firm indicates Qi level, vibrating Stomach collaterals; nourish Stomach Yin with bland flavors (Sheng Bian Dou, Fu Shen, Bei Sha Shen, Yi Yi Ren). Left firm indicates Liver/Kidney Yin damage; use Di Huang, E Jiao, Qi Zi, Wu Wei Zi. String-like pulse with hypochondriac pain: Su Zi, Tao Ren, Jiang Xiang, Yu Jin. Hemoptysis forming plates/bowls: Ge Kejiu's Hua Rui Shi San (Flower and Coral Stone Powder), Zhang Zhongjing's Da Huang Huang Lian Xie Xin Tang. Detailed analysis provides clinical basis.
Zou, twenty-four, chronic blood loss, indicating weak True Yin. At Summer Solstice, Yin generates; in Dog Days, Yang floats outward, Yin hides inward. Normally so. But restless mind secretly consumes Kidney Yin. Collateral blood gathers; Yang touches and overflows. Unstable Yin follows Yang奔腾. Patient feels conflicting rebellious Qi below, blood gushing like a spring. Ren Mai governs bearing; loss of control allows Chong Yang to rush up uncontrollably. Kidney Essence and Liver Blood fail to hold internally. Yang soaring causes blood overflow; Yang sinking causes Yin leakage. Low back pain and cold calves indicate Essence depletion and Lower Jiao damage. Classic says: Deficient Essence is supplemented with flavor-rich substances. Herbs should be quiet, heavy, settling downward. Do not use cooling for blood; do not regulate Lung for cough. This establishes Yuan Hai foundation, prevents Chong Yang rebellion. Recovery takes seasons, requiring stillness and gradual adjustment. Prescription: Ren Shen, Shu Di Huang (stir-fried to ash), Xian He Che Gao (Fresh Placenta Paste), Fu Ling, Chao Hei Qi Zi, Bei Wu Wei Zi, Sha Yuan Ji Li, Zi Shi Ying. (Xu Lingtai: Replace Wu Wei Zi with Mu Li to avoid drawbacks.)
Jiang, sixty-two, chronic anger/labor injury, purple blood clots. First, descend Qi and guide blood: Su Zi, Jiang Xiang Mo, Tao Ren, Hei Shan Zhi, Jin Cha Shi Hu, Zhi Da Huang.
Xu Lingtai said: Ye treats blood diseases, disregarding classics, yet errs heavily by using Mai Dong, Wu Wei Zi, Yu Zhu, Sha Shen. Mai Dong is a heavy Lung tonic for extreme Qi deficiency (e.g., Mai Men Dong Tang), preventing cloying. But for hematemesis/cough with Phlegm-Fire, heavy tonification prevents recovery. Wu Wei Zi's sour astringency stops cough only with Gan Jiang (to disperse cold); never alone. In hematemesis with Fire-Phlegm congestion, we fear non-dispersion/non-descending; forcing retention in Lung is wrong. Sha Shen/Yu Zhu are similar. Ignorance here ensures death from hematemesis. Anciently, Xu Lao (Deficiency Consumption) and Tu Xue (Hematemesis) were distinct. Xu Lao is Cold-Deficiency, treated with warming/tonifying. Tu Xue is mostly Yin-Deficiency/Fire-Excess. Ye stated this clearly but sometimes used Jian Zhong Tang, confusing Xu Lao methods with Tu Xue, showing lack of conviction. Fifty years ago, hematemesis was rare; seniors warned against Lung tonics, saving lives. Now, 50% suffer; those not taking medicine survive, those taking Mai Dong/Wu Wei Zi die. Seasonal factors exist, but drug errors are significant. Beware!
"Guang Bi Ji" states: Two major faults in treating hematemesis today: 1. Exclusive use of cold herbs (Huang Qin, Huang Lian, Zhi Zi, Zhi Mu, Huang Bai) damages Spleen, causing diarrhea, leading to death. 2. Exclusive use of Ren Shen; Lung heat injures Lung further, worsening cough. Rare cases succeed (Qi-deficiency wheezing vs. Yin-deficiency fire). Zhong Chun advocated: Bai Shao + Zhi Gan Cao to constrain Liver; Pi Pa Ye, Mai Dong, Bo He Ye, Ju Hong, Bei Mu to clear Lung; Yi Yi Ren, Huai Shan Yao to nourish Spleen; Jiu Cai, Jiang Xiang, Su Zi to descend Qi; Qing Hao, Bie Jia, Yin Chai Hu, Dan Pi, Di Gu Pi to nourish Yin/clear heat; Chao Zao Ren, Bai Fu Shen, Shan Yu Rou, Qi Zi to tonify Kidney. Effective but requires long-term use. Impatient patients/doctors try random herbs, causing death. Tragic. (Yu Jin is a holy herb for hematemesis; fake ones are the problem.)
Li An: The two faults are clear. Everyone avoids bitter-cold. Only warm-tonification is favored by self-proclaimed famous doctors and texts, killing countless people without realization. Occasional success in Yang-deficiency cases leads to false generalizations. Those who recover with Ren Shen/Huang Qi need no grand theories. Listed herbs are mild, except Jiu Cai, Shan Yu, Qi Zi need caution.
Zhang Feichou treated brothers Zou Kongzhao and Qianzhao. Both had wheezing cough/hematemesis, orthopnea. Kongzhao's pulse: Chi stringy, Cun/Guan peaceful. Fire pressing Lung, plus external pathogen. Blood mixed with phlegm-water, originating from Stomach. Started with Xiao Jian Zhong Tang + Dan Pi to harmonize Ying/Wei. Followed with Yi Gong San minus Bai Zhu, plus Shan Yao, Dan Pi, Ling Sha Dan to settle erratic fire. Lung/Stomach cleared, cured. Qianzhao's pulse: Guan/Chi stringy-thin, like touching a blade. Blood bright red like solid cinnabar, belonging to Shaoyin storage. Declined treatment. Treated Fei Zhongxue: Chronic diaphragmatic obstruction/vomiting, epigastric stabbing pain, bloody sputum. Six pulses thread-thin. Claimed Liu Yin pulse, but Shenmen point showed another pulse reaching Yangxi, indicating Stomach Qi not exhausted, prognosis good. His daughter: Hemoptysis 1-2 times, able to wash/move. Pulse purely stringy-thin-rapid. Stomach Qi exhausted, no hope. Declined treatment.
Li An: These cases show doctors abandoning Yin-deficiency/Fire-flaring Xu Lao. Cured cases used Jian Zhong, Yi Gong, Dang Gui, Huang Qi, Mai Dong, Bai Zhu—indicating Yang-deficiency, not Yin-deficiency/Fire. Texts look good for Xu Lao but ultimately favor Yang-tonification due to lack of personal experience with Yin-deficiency/Fire. In my experience, Yin-deficiency/Fire pulses are fine-rapid-stringy, deemed untreatable, but proper regulation works. Focus on Spleen/Stomach; difficulty is avoiding Ren Shen/Bai Zhu initially. Requires years. When Yin returns and pulse improves, then tonify. By then, disease may resolve itself.
Xu Lingtai said: Fifty years ago, hematemesis was rare. Now increasing. Cases are curable but untreated due to drug errors. 70-80% start from Wind-Cold cough; 20-30% from Xu Lao. Doctors indiscriminately use Shu Di, Ren Shen, Mai Dong, Wu Wei Zi (tonifying/astringent), trapping Wind-Phlegm-Stasis in Lung, causing continuous cough, Qi disturbance, Phlegm formation, leading to death. Trapped Wind-Cold becomes Xu Lao. Everyone knows this, yet ignores it. For hematemesis with cough, clear Lung/descend Qi, slightly nourish Yin. Without cough, collateral rupture in throat; blood exits naturally, no meds needed. Severe cases: use collateral-repairing herbs to fill defects, curing root. Self-healing possible. Patients refusing meds are mocked; those accepting Shu Di/Mai Dong/Ren Shen/Wu Wei Zi accept death. Fate?
Huang Jinfang treated Liu, chronic hemoptysis, intermittent. Blood red but mixed with white drink; complexion red but unstable; breath urgent when moving, calm when sitting; voice harsh; avoids moist foods. Previous cooling/moistening herbs worked initially but failed later. Persimmon cake caused cold sensation. Pulses: Bilateral Guan rapid-stringy-beating, powerless. Used Yi Yi Ren (King), Mai Dong (King); Long Gu, Shou Wu, E Jiao (Minister, nourish Liver). Niu Xi guides Qi/Blood left; Fu Zi, Wu Wei Zi guides Fire/Qi right. Hou Po, Guang Pi remove Spleen/Stomach damp-phlegm. Two doses: Qi calmed, Left Guan rapidness reduced. Spleen/Lung pulses still prominent: Lung cold/Spleen damp remain. Remove Wu Wei Zi, Mai Dong; add Guang Pi, Hou Po to soothe Spleen,