甲申秋孝廉曾奕干次子患遗精三年。百治不瘥。六脉滑缓无力。余曰此肾气下陷。脾虚不能
约水。诸医拘执方书。疗以固涩之药。是治其末而忘其本也。余以补中益气汤去柴胡陈皮加
五味阿胶熟地石枣等物投两剂即止。仍制加减六味丸与服。绝不用龙骨牡蛎金石剽悍之属。
金樱粟壳壅塞队道之物。徒伤肠胃经络耳。余每治此症。率用前药为主量加增减无不愈者。
甲申季夏漳庠林震伯素善饮。因修途劳顿。饥饱失时。复冒 病。白浊经月不瘥。余察
其前治
非辛凉泻火。则滋补壅塞。遂致小腹胀闷。或气喘拒食。六脉滑数无力。余曰此中宫虚热津
液下陷膀胱气化不能分泌以归脾汤去枣仁木香。加炒栀半夏车前黄连服七剂浊止便清。神思
逸爽。夫遗精悉属肾虚浊症多属脾热治法固殊然亦有寒热虚实之别。
甲申仲春一健卒甫三十。素善饮。喜啖辛香病浊窍痛。余以二陈汤加芩连龙胆赤芍车前
。投两剂即止。如此实症本无难治若概施补必变他症。
余犹子知白一儿年十三四每夜尚遗溺一二次。余曰此肾气虚弱不能约液也令服六味丸去
泽泻丹皮。加五味远志鹿胶。服数月前症顿瘥。且复英爽。
愚按失血诸症。经书论之详矣。然而有五脏六腑之殊。阴阳虚实之分。升于上属阳为逆
。脱
于下属阴为顺。出于肺者为咳血为嗽血为衄血。出于心者为劳血为舌血。出于脾胃者为吐血
呕血。出于肝者为郁怒吐血出于肾者为咯血为唾血出于皮肤毛孔者为溢血此皆阳火挟血以上
越也溺血则主膀胱也。淋血则主小肠也。痔血则主胃经也。便血固主大肠。有属风邪下陷者
。有属郁火侵脾者。有属湿热伤脾者。有属积热滞下者此皆阴火烁血而下行也又有热入血室
。寒袭冲任。则为蓄血。又有寒伤经络而脱陷则为无火之症也在妇人暴脱则为崩徐渗则为漏
胃虚而湿热乘之则为赤带从生户而出者方为崩为漏为带从大小便而出者。虽治法与男子同而
得
于胎前产后半产小产之中则又不同也若暴吐暴衄暴崩不止则为孤阳绝阴气血两败也亦当察其
老壮虚实以决生死论其方法有易治者。有难治者。有不治者。有不治而自愈者。有错治而变
他症者。有久治不愈而丧生者。有独见血症者。有兼他症而并见者。悉当察病原之浅深。
年
力之衰旺。六脉之宜忌与元气之虚实寒热。法有必中。剂无妄投。跻夭札于寿域。庶几得之
矣。若以为属火属热。一概混用凉剂涩剂。在治实火实热则可。而属虚火虚热与无火无热之
症。未有不败胃伤脾。绝生化之源。而速人于死者可胜道哉。大都失血之脉。宜沉细濡弱。
或浮沉和缓。或洪大不数。或浮沉滑缓。或虚微或暴吐暴脱。而六脉俱伏此脉与病合则为易
治或见浮芤浮革。或浮沉皆涩。或结或短此脉属虚而病属重则为难治治得其宜。亦多有痊者
。如见浮数洪数。或细数不鼓。或浮大而散。或促代无力。或如滑而无胃气。或弦牢。或实
大或细小劲疾此病与脉反则为不治纵有卢扁。亦为之束手矣故经云阳道实阴道虚越人曰耍为
虚牢为实。失血者脉宜沉细。反浮大而牢者死虚病见实脉也夫血濡脉络。体主阴静。血未失
则脉络濡软而和缓。及火热迫血外溢。真阴耗竭则成阴绝阳亢火充空舍而见实脉致孤阳用事
岂能独生哉又须以色为诊凡失血之后。或面色带黄。青白有神。或目瞑合喜睡。或肢体温和
。饮食如常。或不喜高声。声微不厉。此为顺无别刑克症候。称易治。若其面色青黯无光。
或两颧暴赤。唇口如朱。或乍起乍眠。烦躁不寐。或身体大热。或四肢厥逆。或气喘息粗。
或扬声厉语。或谵狂神昏。或循衣摸床。肉 筋惕。或自汗如雨。头汗独见。或周身厥冷颅
囟独热。或眼眶暴陷。或口渴思水或肢体肿 或脐腹绞痛不休。或胃气已败。呕吐拒食。此
皆凶候不治也。又当以血之色而论。将水试之。浮于上为心肺血。沉于下为肝肾血。不浮不沉
主脾胃中州之血。此特大概然耳。肺血色淡有沫。心血赤如涂朱。脾胃乃多气多血之经其色
不淡不紫。其质不清不浓。肝血浓浊结块。肾血则夹痰红一缕。或色粉红此为金水枯竭肺肾
俱损而待毙又有肝肾两败始由肾炎水涸继因肝火独炽而结块凝重。暴吐不休者。为不治大肠
便血。则当察其属便先为旧瘀。属便后为新脱。与小肠膀胱溺血淋血。亦当详其多少清浊。
至吐衄而口鼻俱出者。则为下厥上竭之症。及痢血而青黯如苔者。此肝脏已败皆不治也。妇
人诸血。亦当视其多寡清浊诊脉虚随症施治故经云至微者理至显者众根于中而微于色不容
不辨也其治之之法。有经治者余列其医案于后。未经治者余详其臆说于中随症参解庶无遗法
亦无枉死。
甲申年秋天，孝廉曾奕干的次子患遗精病三年。经过各种治疗都没有痊愈。六脉滑缓且无力。我说这是肾气下陷，脾虚不能约束水液。各位医生拘泥于医书，用固涩的药物来治疗，这是治标而忘本。我用补中益气汤去掉柴胡、陈皮，加入五味子、阿胶、熟地黄、石枣等药物，服用两剂后症状即止。随后又配制加减六味丸让他服用，绝对不用龙骨、牡蛎、金石等剽悍之品，以及金樱子、粟壳等壅塞通道的药物，那些只会损伤肠胃经络罢了。我每次治疗这种病症，通常以前述药物为主，根据情况适当增减，没有不愈的。
甲申年夏季末，漳州府学生林震伯平时喜欢饮酒。因为路途劳顿，饥饱无常，又感受外邪患病。白浊（尿道口流出白色浑浊液体）持续一个月未愈。我观察之前的治疗，不是用辛凉泻火药，就是滋补导致壅塞，于是导致小腹胀闷，有时气喘拒食。六脉滑数但无力。我说这是中宫（脾胃）虚热，津液下陷至膀胱，气化功能失常，不能正常分泌。我用归脾汤去掉酸枣仁、木香，加入炒栀子、半夏、车前子、黄连，服用七剂后浊止便清，精神清爽。遗精大多属于肾虚，白浊多属于脾热，治疗方法固然不同，但也有寒热虚实之别。
甲申年仲春，一名健壮士兵刚三十岁，平时喜欢饮酒，爱吃辛辣香料，患白浊并伴有尿道疼痛。我用二陈汤加黄芩、黄连、龙胆草、赤芍、车前子，服用两剂后症状即止。像这种实证本来不难治疗，如果一概施用补药，必定会引发其他病症。
我的侄子知白的一个儿子十三四岁，每晚还要遗尿一两次。我说这是肾气虚弱，不能约束尿液。让他服用六味丸去掉泽泻、牡丹皮，加入五味子、远志、鹿角胶。服用几个月后，之前的症状立刻痊愈，并且恢复英武爽朗的精神状态。
我按语：关于失血的各种病症，医书论述得很详细了。然而有五脏六腑的不同，阴阳虚实的区别。血液升于上部属阳，为逆证；脱于下部属阴，为顺证。出于肺的叫咳血、嗽血、衄血；出于心的叫劳血、舌血；出于脾胃的叫吐血、呕血；出于肝的叫郁怒吐血；出于肾的叫咯血、唾血；出于皮肤毛孔的叫溢血。这些都是阳火挟带血液向上溢出。溺血主要责之于膀胱；淋血主要责之于小肠；痔血主要责之于胃经；便血固然主要责之于大肠，有的属于风邪下陷，有的属于郁火侵脾，有的属于湿热伤脾，有的属于积热滞下。这些都是阴火灼烧血液而向下行。又有热入血室，寒袭冲任，则形成蓄血；又有寒伤经络而脱陷，则为无火之症。在妇人暴脱则为崩漏，缓慢渗出则为漏。胃虚而湿热乘之，则产生赤带。从产道而出的才称为崩、漏、带；从大小便而出的，虽然治疗方法与男子相同，但在胎前、产后、半产、小产期间发生的则又不同。如果暴吐、暴衄、暴崩不止，则为孤阳绝阴，气血两败。也应当考察患者的老壮虚实以决断生死，论其方法，有易治的，有难治的，有不可治的，有不治而自愈的，有错治而变生他症的，有久治不愈而丧生的，有独见血症的，有兼见他症而并见的。都应当考察病原的浅深，年力（年龄和体力）的衰旺，六脉的宜忌与元气（人体正气）的虚实寒热。法度必须准确，用药不能妄投，这样才能使早夭者归于长寿之境，大概就得到治病的要领了。如果认为都属于火、属于热，一概混用凉剂和涩剂，对于实火实热是可以的，而对于虚火虚热和无火无热的病症，没有不败坏胃气、损伤脾气、断绝生化之源，从而加速人死亡的，这能说得多吗？大抵失血的脉象，宜见沉细濡弱，或浮沉和缓，或洪大但不数急，或浮沉滑缓，或虚微，或暴吐暴脱而六脉俱伏。这些脉象与病症相合，则为易治。如果见到浮芤、浮革，或浮沉皆涩，或结或短，这些脉象属虚而病症属重，则为难治，治疗得当，也多有痊愈的。如见到浮数、洪数，或细数而不鼓指，或浮大而散，或促代无力，或如滑而无胃气，或弦牢，或实大，或细小劲疾，这些是病与脉相反，则为不治，即使有卢医（扁鹊）再世，也会束手无策。所以医经说：“阳道实，阴道虚。”越人（秦越人/扁鹊）说：“芤为虚，牢为实。”失血者的脉象宜沉细，反见浮大而牢者死，这是虚病见实脉。血液濡养脉络，本性主阴静。血未丢失时，脉络濡软而和缓；等到火热迫血外溢，真阴耗竭，则成阴绝阳亢，火充空舍而见实脉，致使孤阳用事，岂能独自生存呢？又须以面色作为诊断依据。凡失血之后，如果面色带黄，青白有神，或闭目喜睡，或肢体温和，饮食如常，或不喜高声，声音微弱不严厉，此为顺证，无其他刑克症候，称为易治。如果面色青黯无光，或两颧暴赤，唇口如朱，或乍起乍眠，烦躁不寐，或身体大热，或四肢厥逆，或气喘息粗，或扬声厉语，或谵狂神昏，或循衣摸床，肌肉跳动筋脉抽搐，或自汗如雨，头汗独见，或周身厥冷而颅囟独热，或眼眶暴陷，或口渴思饮，或肢体肿胀，或脐腹绞痛不休，或胃气已败，呕吐拒食，这些都是凶候，不治。又应当以血色来论断。将血放入水中测试，浮于上的是心肺之血，沉于下的是肝肾之血，不浮不沉主脾胃中州之血。这只是大概情况而已。肺血色淡有泡沫，心血赤红如涂朱砂，脾胃乃多气多血之经，其色不淡不紫，其质不清不浓。肝血浓浊结块，肾血则夹痰呈红一缕，或色粉红，此为金水枯竭，肺肾俱损而待毙。又有肝肾两败，始由肾炎水涸，继因肝火独炽而结块凝重，暴吐不休者，为不治。大肠便血，则应当察其属于便前旧瘀还是便后新脱。与小肠膀胱溺血、淋血，也应当详查其多少清浊。至于吐衄而口鼻俱出者，则为下厥上竭之症；及痢血而青黯如苔者，此肝脏已败，皆不治也。妇人诸血，也应当视其多寡清浊，诊脉随症施治。所以医经说：“至微者理，至显者众，根于中而微于色，不容不辨也。”其治疗方法，有经治愈的案例，我列其医案于后；未经治愈的，我详述我的见解于其中，随症参解，庶无遗漏之法，也无枉死之人。
In the autumn of Jiashen year, the second son of Zeng Yigan, a Xialian (successful candidate in the imperial examination), suffered from spermatorrhea for three years. Various treatments failed to cure him. His six pulses were slippery, slow, and weak. I said this was due to Kidney Qi sinking, and Spleen deficiency failing to control water metabolism. The other physicians, adhering strictly to medical texts, treated it with astringent medicines. This treats the branch but forgets the root. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), removing Chaihu (Bupleuri Radix) and Chenpi (Citri Reticulatae Pericarpium), and adding Wuweizi (Schisandrae Chinensis Fructus), Ejiao (Asini Corii Colla), Shudihuang (Rehmanniae Radix Preparata), and Shizao, among others. After two doses, the symptoms stopped. Subsequently, I prepared Jiajian Liuwei Wan (Modified Six-Ingredient Pill with Rehmannia) for him to take. I absolutely avoided Prolongate (Longgu, Os Draconis), Oyster Shell (Muli, Ostreae Concha), and other harsh mineral substances, as well as Jin Yingzi (Chrysanthemi Fructus) and Susu (Papaveris Pericarpium), which are clogging agents; they would only damage the intestines, stomach, and meridians. Whenever I treat this condition, I generally use the aforementioned medicines as the main formula, making appropriate additions and subtractions according to the case, and there has been no failure.
In the late summer of Jiashen year, Lin Zhenbo, a student at the Zhangzhou Academy, who usually enjoyed drinking alcohol, fell ill due to fatigue from travel and irregular eating habits. He contracted an external pathogen. Leukorrhea (white turbid discharge from the urethra) persisted for a month without improvement. I observed that previous treatments had either used acrid-cool fire-draining herbs or tonifying herbs that caused stagnation, leading to abdominal distension and fullness, sometimes accompanied by asthma and refusal to eat. His six pulses were slippery, rapid, yet weak. I said this was due to deficient heat in the Middle Jiao (Spleen and Stomach), causing body fluids to sink into the Bladder, where Qi transformation failed to separate clear from turbid. I used Guipi Tang (Restore the Spleen Decoction), removing Zaoren (Ziziphi Spinosae Semen) and Muxiang (Aucklandiae Radix), and adding Chao Zhizi (Gardeniae Fructus Preparatus), Banxia (Pinelliae Rhizoma), Cheqian (Plantaginis Semen), and Huanglian (Coptidis Rhizoma). After seven doses, the turbidity stopped, urination became clear, and his spirit felt refreshed. Spermatorrhea generally belongs to Kidney deficiency, while leukorrhea often belongs to Spleen heat; although the treatment methods differ, there are distinctions between cold and heat, deficiency and excess.
In mid-spring of Jiashen year, a robust soldier, just thirty years old, who liked drinking and consuming pungent and aromatic foods, suffered from leukorrhea with pain in the urinary orifice. I used Erchen Tang (Two-Aged Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Longdancao (Gentianae Radix), Chishao (Paeoniae Radix Rubra), and Cheqian (Plantaginis Semen). After two doses, the symptoms ceased. Such excess conditions are inherently easy to treat; if tonics are indiscriminately applied, other syndromes will inevitably arise.
My nephew Zhibai’s son, aged thirteen or fourteen, experienced nocturnal enuresis one or twice every night. I said this was due to weak Kidney Qi failing to control urine retention. I prescribed Liuwei Wan (Six-Ingredient Pill with Rehmannia), removing Zexie (Alismatis Rhizoma) and Danpi (Moutan Cortex), and adding Wuweizi (Schisandrae Chinensis Fructus), Yuanzhi (Polygalae Radix), and Luajiao (Cornu Cervi Degelatinatum). After taking it for several months, his previous symptoms completely resolved, and he regained his vigorous and alert demeanor.
My commentary: Regarding various hemorrhagic syndromes, medical classics have discussed them in detail. However, there are differences among the five Zang and six Fu organs, and distinctions between Yin/Yang and deficiency/excess. Blood rising upward is Yang and indicates a rebellious syndrome; blood escaping downward is Yin and indicates a compliant syndrome. Hematemesis originating from the Lung is called cough hemoptysis, sputum hemoptysis, or epistaxis; from the Heart, it is labor hematochezia or lingual bleeding; from the Spleen and Stomach, it is vomiting blood or hematemesis; from the Liver, it is anger-induced hematemesis; from the Kidney, it is spitting blood or salivary bleeding; from the skin pores, it is extravasated blood. These are all cases where Yang Fire carries blood upward. Hematuria primarily involves the Bladder; strangury blood primarily involves the Small Intestine; hemorrhoidal blood primarily involves the Stomach Meridian; melena primarily involves the Large Intestine. Some cases belong to Wind Evil sinking, some to constrained Fire invading the Spleen, some to Damp-Heat injuring the Spleen, and some to accumulated Heat causing dysentery. These are all cases where Yin Fire scorches blood, causing it to flow downward. There are also cases of Heat entering the Blood Chamber, or Cold attacking the Chong and Ren vessels, resulting in blood stasis; or Cold injuring the meridians causing collapse, resulting in a non-fire syndrome. In women, sudden collapse manifests as metrorrhagia (beng lou), while slow oozing manifests as leukorrhea-like bleeding. If Stomach deficiency allows Damp-Heat to invade, red leukorrhea arises. Bleeding from the genital opening constitutes metrorrhagia, leukorrhea, or leukorrhea; bleeding from the large or small intestine, although treated similarly to men, differs when occurring during pregnancy, postpartum, miscarriage, or incomplete abortion. If sudden vomiting, sudden epistaxis, or sudden metrorrhagia does not stop, it indicates isolated Yang and severed Yin, with both Qi and Blood exhausted. One must examine the patient’s age, strength, deficiency, and excess to determine life or death. Regarding treatment methods, some are easy to cure, some difficult, some incurable, some self-healing, some worsened by incorrect treatment, some fatal despite prolonged treatment, some presenting solely as blood disorders, and some accompanied by other syndromes. One must investigate the depth of the pathogen, the decline or vigor of age and physical strength, the suitability or contraindication of the six pulses, and the deficiency/excess and cold/heat of Yuan Qi (Original Qi). Treatment principles must be precise, and prescriptions should not be arbitrary. Only then can premature death be prevented and longevity achieved. If one assumes all cases belong to Fire or Heat and indiscriminately uses cooling and astringent formulas, this may work for Excess Fire and Excess Heat, but for Deficient Fire, Deficient Heat, or non-Fire/non-Heat syndromes, it will invariably damage the Stomach and Spleen, cut off the source of generation and transformation, and hasten death. How can such practices be justified? Generally, the pulse in hemorrhagic diseases should be deep, fine, soggy, and weak, or floating/sinking and harmonious and slow, or surging and large but not rapid, or floating/sinking and slippery and slow, or deficient and minute, or even hidden after sudden massive bleeding. When these pulses match the disease, it is easy to treat. If floating-knotted, floating-leather, or both floating and sinking pulses are choppy, knotted, or short, indicating deficiency with severe disease, it is difficult to treat, though proper treatment can still lead to recovery. If the pulse is floating-rapid, surging-rapid, fine-rapid and non-resilient, floating-large and scattered, choppy-decelerated and weak, slippery but lacking Stomach Qi, wiry-taut, solid-large, or fine-small and forceful-rapid, the disease and pulse contradict each other, indicating incurability. Even with the skill of Lu Bianque, one would be at a loss. Thus, the Classics state: "The pathway of Yang is solid; the pathway of Yin is empty." Yue Ren (Qin Yueren/Bian Que) said: "Kou (knotted) indicates deficiency; Lao (taut) indicates excess." In hemorrhagic diseases, the pulse should be deep and fine; if it reversely becomes floating-large and taut, death ensues, as this is a deficiency syndrome manifesting with an excess pulse. Blood nourishes the collaterals and its nature is Yin and quiet. Before blood loss, collaterals are moist, soft, harmonious, and slow. When Fire forces blood to overflow externally and True Yin is exhausted, Yin is severed and Yang rebels, Fire fills the empty chambers, manifesting as an excess pulse, causing isolated Yang to dominate. How can life persist? Diagnosis must also rely on complexion. After blood loss, if the face is yellowish, greenish-white with spirit, or the patient prefers closing eyes and sleeping, limbs are warm, diet is normal, voice is low and not harsh, this is a compliant syndrome without conflicting signs, considered easy to treat. If the face is dark green/dull, malar flush is sudden, lips/mouth are vermilion, sleep is intermittent with restlessness, body is hot, limbs are cold, breathing is coarse, speech is loud/aggressive, delirium/coma occurs, grasping clothes/twitching muscles happens, sweating is profuse like rain, head sweat only, whole body cold with hot fontanelle, eye sockets sunken, thirst for water, limb edema, continuous umbilical/abdominal colic, Stomach Qi is defeated with vomiting/refusal to eat—these are ominous signs, incurable. Furthermore, analyze the blood color. Test with water: floating indicates Heart/Lung blood; sinking indicates Liver/Kidney blood; neither floating nor sinking indicates Spleen/Stomach blood. This is a general rule. Lung blood is pale with foam; Heart blood is red like vermilion; Spleen/Stomach, being abundant in Qi and Blood, is neither pale nor purple, neither thin nor thick. Liver blood is thick, turbid, and clotted; Kidney blood contains phlegm, appearing as a red thread or pinkish-red, indicating exhaustion of Metal and Water, damage to Lung and Kidney, awaiting death. Another scenario is dual failure of Liver and Kidney: starting with Kidney inflammation and fluid depletion, followed by solitary blazing of Liver Fire forming heavy clots, with incessant vomiting—this is incurable. For Large Intestine melena, distinguish whether it is old stasis before defecation or fresh loss after. For Small Intestine/Bladder hematuria/strangury, examine quantity and clarity. Epistaxis and hematemesis occurring simultaneously from mouth and nose indicate lower rebellion and upper exhaustion. Dysenteric blood that is dark green/black like moss indicates Liver failure, also incurable. Women’s hemorrhages should also be assessed by quantity and clarity, with pulse diagnosis guiding treatment. As the Classics say: "The subtle principle is profound; the obvious manifestations are numerous. Rooted internally but subtle externally, distinction is imperative." Regarding treatment, I list cured cases below; for uncured ones, I detail my theoretical analysis above, adapting to symptoms to avoid missed methods or unjust deaths.