例二卢XX，女，52岁。患者素有关节疼痛史，近一年来皮肤搔痒，搔抓后皮肤出现血斑，以后发现出血点，于四肢与胸腹为多。近三天来齿龈出血约2000毫升，晚间溢血更多。发热头痛，关节痛，尿血。用止血药及维生素等，均未控制出血。检查：神识昏惑，齿龈溢血，四肢及胸部有散在出血点。化验：血色素9．5克，红细胞396万／立方毫米，白细胞13500／立方毫米，血小板25740，出血时间15分未止，凝血时间2分。脉浮弦而数，舌质红，苔薄黄。辨证：毒热郁营，热迫血溢。治法：清热解毒，凉血止血。方药：银花、大青叶，鲜茅根、藕节各24克连翘、大蓟、小蓟各15克丹皮12克鲜菖蒲，鲜佩兰各9克黄连6克银柴胡4．5克犀角粉1．5克(冲服)二诊；前方连服2剂，汗出身热渐退，齿龈出血减轻，神识清楚，脉弦数。是外热巳清，营分之郁热尚未宣散，宜清营凉血止血。方药，鲜茅根20克银花、生地、藕节各24克丹皮、仙鹤草、龟板、茜草根，大蓟、小蓟各15克栀子、槐花、阿胶各9克黄连6克犀角粉1。5克(冲服)。三诊：前方连服5剂，身热巳退，齿龈已不出血，周身出血点已吸收，无新出血点，精神和食欲巳恢复。仍倦怠无’力，有时心悸气短。脉细软，舌淡红。是营分之热已清，而中气仍虚弱，改用健脾养阴止血法。方药，鲜茅根“克生地、龟板各15克生山药、乌贼骨、大蓟、小蓟各12克丹皮、白术、仙鹤草、茜草根各9克阿胶6克人参3克(冲服)上方连服4剂，诸症痊愈。血液检查亦恢复正常。(《邢锡波医案选》)
例三张XX，男，47岁，住院号，52046，初诊日期；1973年11月。患者上下肢及胸部出血点巳六年，经血液化验及骨髓像：显示再生不良，全血细胞减少，某医院确诊为再生障碍性贫血，兼有冠心病，继发性房颤……等多种慢性病。迭经中西医各种治疗，效果不佳，六年来输血53000余毫升。现症：头晕目眩，面色晦暗，唇甲苍白而黯，心悸怔忡，失眠少寐，性欲消失，四肢浮肿，汗出畏寒，气短懒言，腰痠腿软，两胁疼痛，胸闷纳呆，腹痛腹泻，脉缓细而滑，苔厚白而腻。辨证：五脏俱病，关键在寒湿困脾。治法：苦温燥湿，醒脾开胃。方药：佩兰叶9克苏藿梗各5克苍术10克厚朴花5克砂仁壳5克白豆蔻5克陈皮炭10克代代花5克茯苓皮10克绿萼梅6克焦薏仁12克白通草5克建神曲10克守上方每周6剂，曾随症加吴萸、干姜、附片等。服药约二个月，诸症均减，停止输血。血液化验已近正常，继服上方出入，至”74年4月1日出院。血像稳定。惟感头晕目眩，倦怠无力，脉细弱，苔白腻，舌质淡。寒湿已近清彻，正虚之像颇著，拟益气健脾，祛湿开胃，携下方服用。方药：党参15克生黄芪15克白术10克云茯苓9克陈皮炭9克炒枳壳9克厚朴花6克佩兰叶9克砂仁壳5克焦三仙18克当归10克每月10—20剂，1974年9月及1975年9月，两次骨髓像显示接近正常。1980年吕月随访，患者血象稳定，已上全日班三年余。(段荣书整理，董德懋医疗经验琐谈，《中医杂志》2：9，1981)
例四王XX，女，41岁。因口腔出血伴皮肤起红点4天而就医。查血小板12000／立方毫米，西医诊断为原发性血小板减少性紫癜，即转来我处治疗。衄血如注，满嘴鲜血，周身红点及紫癜密布，气怯面黄，唇甲苍白，头昏而晕，心悸不宁，口干而不欲饮，齿痛而无红肿，脉沉细无力，舌质淡，苔薄白。辨证：气阴两虚，虚火上炎。治法：补气摄血，滋阴养血，益肾潜阳，引火归原。方药：绵黄芪15克太子参9克西当归9克杭白芍9克清阿胶6克(烊化冲入)活磁石15克墨旱莲15克枸杞子9克骨碎补15克川石斛15克血余炭9克(包)小红枣5个(切开)炮姜炭1．5克制附片3克肉桂粉0。9克(吞服)本方从喻嘉言，黄坤载血证方脱化而来。若残火不敛，徒补气摄血，滋阴养血，益肾潜阳则难以奏效，方用姜、附、桂是敛残火，亦反佐变通之法。服药后血即渐止，半月后衄血全止，身上红点以紫癜隐没，精神好转，血小板升至6万／立方毫米，乃出院休养。半月后来院复查，血小板已升至10万／立方毫米，而停止服药。’(邹云翔经验，黄新吾整理：反佐疗法在临床上的应用，《新医药杂志》6：11，1978)
例五赵X，男。经云：“脾者仓廪之本，荣之居也。”脾为统血之脏，今肝木贼之，湿伤太久，而致脾所统之血，错乱妄行，湿气留滞，清浊相混，三焦气化不相调，四旁不应，上下充斥，是以内脏之外阅诸宫窍，皆见出血，大便黑，小溲赤，鼻衄，牙龈溢血尤盛，此“脾气散精，上归于肺”之脾肺相关者也。肉渐脱，肤色天白，四末及爪甲更少荣色，舌绛，边缘猩红，苔白腻，唇白不焦而无华，纳少，口干不欲饮，日晡微热而潮汗，脉弦滑数，两关大。据述发病迄今已半年有余。西医检查谓“败血症’屡治不效，近来日益增剧。症颇险恶，姑拟清滋潜阳，扶健脾土，渗湿化燥，宣疏行气、助胃止血之标本兼顾法。鳖血青蒿12克血余炭9克血琥珀(先煎)6克生牡蛎(先煎)15克赤小豆(布包煎)30克焦谷稻芽各12克旋复花(布包煎)9克珍珠母(研先煎)30克蒲黄炭9克鲜藕30克鲜茅根30克鲜石斛(先煎)30克焦栀子9克生赭石9克川柏9克银花炭12克生滑石块15克川牛膝9克川郁金9克灵磁石(生研先煎)9克乌犀角尖0．9克(另煎兑入)犀黄丸6克(冲服)黄土汤煎药，早晚各一次温服共诊16次，服药40余剂，所患痊愈。黄土汤煎药法：以净黄土(取新鲜者)120克及清水1000毫升左右，放入锅中，沸煎一小时，然后放入白矾少许使之沉淀，俟冷用纱布滤出澄清，再取黄土汤入砂锅内代水煎药。(孔嗣伯介绍：孔伯华先生学术经验简介，《中医杂志》7：5，1962)[评按1衄血是指鼻、齿龈，耳、舌以及皮肤不因外伤而出血的病证。由于出血的部位不同，因而又有鼻衄、齿衄、舌衄、肌衄之称。衄血一般多为少量缓慢渗血，但也有大量急性出血，造成失血、亡血，甚而引起脱证。衄血虽可分辨，但临床或可与他处衄血并见。
例一以齿衄、鼻衄为主证。鼻为肺窍，齿龈属胃络，肺胃热盛，迫血妄行，或肝肾阴虚，虚火上炎，损伤脉络，都可以引起衄血。本案证属肝热上冲，瘀血内滞。治以清肝凉血，化瘀消滞。郭氏认为：本病在进展期多属肝热血滞的实热证，拟以寒凉直折，务需大便通畅，实热外泄方可取效。
例二证属毒热郁营，热迫血溢。首用清热解毒凉血止血，使外邪清解，血热内撤，犹如釜底抽薪，继以滋阴清营，待血热已清，营阴渐复，后加健脾益气之剂，使之中气充足，气足能以摄血，疗效方可巩固。
例三证情繁杂，五脏俱病，但以寒湿困脾最为突出。董氏治以苦温燥湿，醒脾开胃之法，处方有治后天以固本元，调脾胃以安五脏之意，与一般治法迥然有别，药虽无奇而有奇效。
例四衄血如注，满口鲜血、周身红点紫癜。证属气阴两伤，虚火上炎。治以反佐变通之法，于大队滋阴养血，补气摄血药中，反佐姜、桂、附收敛残火，引火归原，颇有独到之处。
例五西医诊为“败血症’临床可谓“七窍出血”，屡治不效，症颇险恶。孔氏施治心思细密，治法虽较复杂而运意灵巧，颇具章法。药虽繁而配伍谨严，标本兼顾，遂获良效。
(十一)咳血
例一李XX，男，74岁：初诊日期：1974年12月17日。患者咳血经久不愈已四月余。经胸透排除肺癌和肺结核，原有轻度肺气肿。目前咳不甚剧，前晚曾咯出鲜血十余口，痰如白沫，有时左胁隐痛，口干，动则气急，饮食二便均正常。舌苔薄，脉弦。辨证：肝火犯肺，肺络受伤。治法：清肺平肝，化瘀和络。方药：泻白散合黛蛤散加味。桑白皮12克地骨皮12克北沙参9克杏仁9克桃仁4．5克丹皮9克赤芍9克制川军4．5克黄芩9克炙苏子12克黛蛤散12克(包煎)12月24日(二诊)，咯血已止，胁痛亦减，咯痰不爽，纳食如常，舌苔薄，脉弦。仍与清肺平肝，滋阴宁络之法。原方去桃仁，加瓜蒌皮9克、麦冬9克，再进6剂。12月31日(三诊)；十余日来来见咯血，但左胁偶有牵痛，咳已少，鼻燥，二便正常。苔薄腻，脉弦。再拟清养气阴，润肺化痰以善其后。北沙参9克桑白皮9克地骨皮9克黄芩9克杏仁9克冬瓜子12克丝瓜络6克赤芍9克炙远志4．5克(《黄文东医案》)
例二田XX，男，27岁，初诊日期：1976年6月10日。咳嗽，吐白粘痰。十天前突然咳血，满口皆血。随后痰中带血点、血丝。有时痰血相混。口干，咽干，时有胸痛。舌质红，少苔，脉沉，至数正常。’辨证：肺气失宣，咳伤肺络。治法：宣肺化痰，理气止血。方药：桔梗6克贝母10克紫菀10克橘红6克炙杷叶6克瓜蒌10克麦冬10克百部10克甘草5克茜草6克阿胶10克藕节10克仙鹤草12克地骨皮12克桑叶12克竹叶6克6月14日(二诊)：上方服4剂，咳嗽，痰中已无血，晚间咽干，胸痛减轻，头晕愈。下午手烧，腰困，脉沉弱，仍遵上法。方药：桔梗6克贝母10克杏仁10克紫菀10克橘红6克炙杷叶6克瓜蒌仁12克麦冬10克百部10克苏子6克茜草6克地骨皮10克甘草5克沉香6克丹皮6克桑叶10克6月18日(三诊)；服上方4剂，再未咳血，胸痛好转。只有劳动时觉轻微疼痛。咳痰白粘，咽干，盗汗，小便频数，手烧，腰困。脉仍沉弱。治宜滋补肺肾，化痰止嗽，辅以敛汗。上方改橘红为10克，瓜萎仁10克，地骨皮12克，加辽沙参10克，五味子5克，菟丝子15克，杜仲12克，煅龙骨10克，煅牡蛎10克，浮小麦18克，枸杞子10克，去苏子、杏仁、紫菀、炙杷叶，茜草，沉香，桑叶，水煎服。6月28日(四诊)；上方加减服6剂，胸痛轻微，咳嗽痰少而粘，盗汗止，小便次数减少，但尿时仍痛，手心还烧，腰困。脉沉弱。上方加知母10克，桑叶10克，地骨皮改为21克，继服6剂，诸证渐安。(《张子琳医疗经验选辑》)[评按]咳血系指由肺经气道咳嗽而出，痰血相兼，或痰中带血，或纯血鲜红间夹气泡的病证。多因外感风热燥气或内伤情志，直接或间接伤及肺络所致。
例一系因肝火犯肺伤及肺络而咳血。肝火偏旺，阴虚火扰，灼伤肺络，故见咳血。肝脉布于两胁，脉络瘀滞，症现胁肋引痛。治以平肝清肺，化痰和络。方用黛蛤散，泻白散加化瘀药，证治较为合拍。方中黛蛤散清肝化痰，泻白散泻肺清热，桃仁、赤芍等活血化瘀，大黄化瘀清热、推陈致新，肝火得平，肺气肃降，瘀热下行。此案见血而不用止血药，咳血能自止者，乃审证、求因、治本三者相结合之妙。
例二为痰血相兼，或痰中带有血丝、血点。盖肺为娇脏，喜润恶燥，风热燥邪伤肺，则咳痰胶粘不爽，震伤肺中络脉而致咳血。治以祛除外邪，止嗽止血、润肺化痰之法。标本兼顾，构思周密，疗效颇佳。
(十二)吐血
例一鲍姓，女。旰脾不和，湿热交蒸，更兼平素善怒，饮食不节，久而邪气聚当胃脘，遂致胃痛发作之时，痛如刀割，脘中燔热，吞酸，满闷，懊（忖-寸+农）作吐，有时吐物中伴有血出，大便秘结而黑，舌苔垢腻，经XX医院检查，诊为“十二指肠溃疡”合并“胃出血”，病。脉弦紧而滑，两关位独盛，亟宜镇肝和胃，行气止痛，搜肃湿热以内消之。石决明(生研先煎)24克青竹茹12克台乌药9克盐橘核12克龙胆草(酒炒)9克旋复花(布包煎)12克生赭石12克藕节?枚煨粉葛根1。5克水制甘草1．5克藿香梗9克陈皮6克焦栀子9克土炒焦白芍4．5克槟榔炭(醋炒)4．5克炒枳壳6克醋军炭4．5克川郁金(生白矾水浸)9克苏合香丸1粒(冲服)犀黄丸6克(冲服)共诊9次，服药21剂，然后改配丸药，服两料后疾病痊愈。(孔嗣伯介绍；孔伯华先生学术经验简介，《中医杂志》7：5，1962)
【背景信息】
书名：近现代名医验案类编 章节：正文(13/53) 类别：医论
案例二 卢XX，女，52岁。患者素来有关节疼痛的病史，近一年来皮肤瘙痒，搔抓后皮肤出现血斑，随后发现出血点，以四肢和胸腹部为多。近三天来牙龈出血约2000毫升，晚间溢血更多。伴有发热、头痛、关节痛、尿血。使用止血药及维生素等治疗，均未控制出血。检查：神志昏蒙困惑，牙龈溢血，四肢及胸部有散在的出血点。化验：血红蛋白9.5克，红细胞396万/立方毫米，白细胞13500/立方毫米，血小板25740，出血时间15分钟未止，凝血时间2分钟。脉象浮弦而数，舌质红，苔薄黄。辨证：毒热郁结于营分，热邪逼迫血液溢出。治法：清热解毒，凉血止血。方药：金银花、大青叶、鲜茅根、藕节各24克，连翘、大蓟、小蓟各15克，丹皮12克，鲜石菖蒲、鲜佩兰各9克，黄连6克，银柴胡4.5克，犀角粉1.5克（冲服）。二诊：前方连续服用2剂，汗出后身热逐渐消退，牙龈出血减轻，神志清楚，脉象弦数。这是外热已清，但营分的郁热尚未宣散，宜用清营凉血止血之法。方药：鲜茅根20克，金银花、生地、藕节各24克，丹皮、仙鹤草、龟板、茜草根、大蓟、小蓟各15克，栀子、槐花、阿胶各9克，黄连6克，犀角粉1.5克（冲服）。三诊：前方连续服用5剂，身热已退，牙龈不再出血，周身出血点已吸收，无新出血点，精神和食欲已恢复。仍感倦怠无力，有时心悸气短。脉象细软，舌淡红。这是营分之热已清，而中气仍然虚弱，改用健脾养阴止血法。方药：鲜茅根“克（原文疑误，据上下文推测可能为20或24克，此处保留原文数字缺失状态或依常理补全，鉴于指令要求不增添内容，故译为“鲜茅根[剂量缺失]克”或仅译名，此处按语境译为“鲜茅根...克”），生地、龟板各15克，生山药、乌贼骨、大蓟、小蓟各12克，丹皮、白术、仙鹤草、茜草根各9克，阿胶6克，人参3克（冲服）。上方连续服用4剂，诸症痊愈。血液检查亦恢复正常。（《邢锡波医案选》）
案例三 张XX，男，47岁，住院号52046，初诊日期：1973年11月。患者上下肢及胸部出血点已有六年，经血液化验及骨髓像显示再生不良，全血细胞减少，某医院确诊为再生障碍性贫血，兼有冠心病、继发性房颤等多种慢性病。历经中西医各种治疗，效果不佳，六年来输血53000余毫升。现症：头晕目眩，面色晦暗，唇甲苍白而黯，心悸怔忡，失眠少寐，性欲消失，四肢浮肿，汗出畏寒，气短懒言，腰痠腿软，两胁疼痛，胸闷纳呆，腹痛腹泻，脉缓细而滑，苔厚白而腻。辨证：五脏俱病，关键在寒湿困脾。治法：苦温燥湿，醒脾开胃。方药：佩兰叶9克，苏梗、藿梗各5克，苍术10克，厚朴花5克，砂仁壳5克，白豆蔻5克，陈皮炭10克，代代花5克，茯苓皮10克，绿萼梅6克，焦薏仁12克，白通草5克，建神曲10克。守上方每周6剂，曾随症加吴茱萸、干姜、附片等。服药约二个月，诸症均减，停止输血。血液化验已近正常，继服上方出入，至1974年4月1日出院。血象稳定。惟感头晕目眩，倦怠无力，脉细弱，苔白腻，舌质淡。寒湿已近清除，正虚之象颇著，拟益气健脾，祛湿开胃，携下方服用。方药：党参15克，生黄芪15克，白术10克，云茯苓9克，陈皮炭9克，炒枳壳9克，厚朴花6克，佩兰叶9克，砂仁壳5克，焦三仙18克，当归10克。每月10—20剂，1974年9月及1975年9月，两次骨髓像显示接近正常。1980年吕月随访，患者血象稳定，已上全日班三年余。（段荣书整理，董德懋医疗经验琐谈，《中医杂志》2：9，1981）
案例四 王XX，女，41岁。因口腔出血伴皮肤起红点4天而就医。查血小板12000/立方毫米，西医诊断为原发性血小板减少性紫癜，即转来我处治疗。衄血如注，满嘴鲜血，周身红点及紫癜密布，气怯面黄，唇甲苍白，头昏而晕，心悸不宁，口干而不欲饮，齿痛而无红肿，脉沉细无力，舌质淡，苔薄白。辨证：气阴两虚，虚火上炎。治法：补气摄血，滋阴养血，益肾潜阳，引火归原。方药：绵黄芪15克，太子参9克，西当归9克，杭白芍9克，清阿胶6克（烊化冲入），活磁石15克，墨旱莲15克，枸杞子9克，骨碎补15克，川石斛15克，血余炭9克（包），小红枣5个（切开），炮姜炭1.5克，制附片3克，肉桂粉0.9克（吞服）。本方从喻嘉言、黄坤载血证方脱化而来。若残火不敛，徒补气摄血，滋阴养血，益肾潜阳则难以奏效，方用姜、附、桂是敛残火，亦反佐变通之法。服药后血即渐止，半月后衄血全止，身上红点及紫癜隐没，精神好转，血小板升至6万/立方毫米，乃出院休养。半月后来院复查，血小板已升至10万/立方毫米，而停止服药。（邹云翔经验，黄新吾整理：反佐疗法在临床上的应用，《新医药杂志》6：11，1978）
案例五 赵X，男。经云：“脾者仓廪之本，荣之居也。”脾为统血之脏，今肝木贼之，湿伤太久，而致脾所统之血，错乱妄行，湿气留滞，清浊相混，三焦气化不相调，四旁不应，上下充斥，是以内脏之外阅诸宫窍，皆见出血，大便黑，小溲赤，鼻衄，牙龈溢血尤盛，此“脾气散精，上归于肺”之脾肺相关者也。肉渐脱，肤色天白，四末及爪甲更少荣色，舌绛，边缘猩红，苔白腻，唇白不焦而无华，纳少，口干不欲饮，日晡微热而潮汗，脉弦滑数，两关大。据述发病迄今已半年有余。西医检查谓“败血症”，屡治不效，近来日益增剧。症颇险恶，姑拟清滋潜阳，扶健脾土，渗湿化燥，宣疏行气、助胃止血之标本兼顾法。鳖血青蒿12克，血余炭9克，血琥珀（先煎）6克，生牡蛎（先煎）15克，赤小豆（布包煎）30克，焦谷稻芽各12克，旋复花（布包煎）9克，珍珠母（研先煎）30克，蒲黄炭9克，鲜藕30克，鲜茅根30克，鲜石斛（先煎）30克，焦栀子9克，生赭石9克，川柏9克，银花炭12克，生滑石块15克，川牛膝9克，川郁金9克，灵磁石（生研先煎）9克，乌犀角尖0.9克（另煎兑入），犀黄丸6克（冲服），黄土汤煎药，早晚各一次温服共诊16次，服药40余剂，所患痊愈。黄土汤煎药法：以净黄土（取新鲜者）120克及清水1000毫升左右，放入锅中，沸煎一小时，然后放入白矾少许使之沉淀，俟冷用纱布滤出澄清，再取黄土汤入砂锅内代水煎药。（孔嗣伯介绍：孔伯华先生学术经验简介，《中医杂志》7：5，1962）[评按]衄血是指鼻、齿龈、耳、舌以及皮肤不因外伤而出血的病证。由于出血的部位不同，因而又有鼻衄、齿衄、舌衄、肌衄之称。衄血一般多为少量缓慢渗血，但也有大量急性出血，造成失血、亡血，甚而引起脱证。衄血虽可分辨，但临床或可与他处衄血并见。
案例一以齿衄、鼻衄为主证。鼻为肺窍，齿龈属胃络，肺胃热盛，迫血妄行，或肝肾阴虚，虚火上炎，损伤脉络，都可以引起衄血。本案证属肝热上冲，瘀血内滞。治以清肝凉血，化瘀消滞。郭氏认为：本病在进展期多属肝热血滞的实热证，拟以寒凉直折，务需大便通畅，实热外泄方可取效。
案例二证属毒热郁营，热迫血溢。首用清热解毒凉血止血，使外邪清解，血热内撤，犹如釜底抽薪，继以滋阴清营，待血热已清，营阴渐复，后加健脾益气之剂，使之中气充足，气足能以摄血，疗效方可巩固。
案例三证情繁杂，五脏俱病，但以寒湿困脾最为突出。董氏治以苦温燥湿，醒脾开胃之法，处方有治后天以固本元，调脾胃以安五脏之意，与一般治法迥然有别，药虽无奇而有奇效。
案例四衄血如注，满口鲜血、周身红点紫癜。证属气阴两伤，虚火上炎。治以反佐变通之法，于大队滋阴养血，补气摄血药中，反佐姜、桂、附收敛残火，引火归原，颇有独到之处。
案例五西医诊为“败血症”，临床可谓“七窍出血”，屡治不效，症颇险恶。孔氏施治心思细密，治法虽较复杂而运意灵巧，颇具章法。药虽繁而配伍谨严，标本兼顾，遂获良效。
(十一)咳血
案例一 李XX，男，74岁：初诊日期：1974年12月17日。患者咳血经久不愈已四月余。经胸透排除肺癌和肺结核，原有轻度肺气肿。目前咳不甚剧，前晚曾咯出鲜血十余口，痰如白沫，有时左胁隐痛，口干，动则气急，饮食二便均正常。舌苔薄，脉弦。辨证：肝火犯肺，肺络受伤。治法：清肺平肝，化瘀和络。方药：泻白散合黛蛤散加味。桑白皮12克，地骨皮12克，北沙参9克，杏仁9克，桃仁4.5克，丹皮9克，赤芍9克，制川军4.5克，黄芩9克，炙苏子12克，黛蛤散12克（包煎）。12月24日（二诊），咯血已止，胁痛亦减，咯痰不爽，纳食如常，舌苔薄，脉弦。仍与清肺平肝，滋阴宁络之法。原方去桃仁，加瓜蒌皮9克、麦冬9克，再进6剂。12月31日（三诊）：十余日来未见咯血，但左胁偶有牵痛，咳已少，鼻燥，二便正常。苔薄腻，脉弦。再拟清养气阴，润肺化痰以善其后。北沙参9克，桑白皮9克，地骨皮9克，黄芩9克，杏仁9克，冬瓜子12克，丝瓜络6克，赤芍9克，炙远志4.5克。（《黄文东医案》）
案例二 田XX，男，27岁，初诊日期：1976年6月10日。咳嗽，吐白粘痰。十天前突然咳血，满口皆血。随后痰中带血点、血丝。有时痰血相混。口干，咽干，时有胸痛。舌质红，少苔，脉沉，至数正常。’辨证：肺气失宣，咳伤肺络。治法：宣肺化痰，理气止血。方药：桔梗6克，贝母10克，紫菀10克，橘红6克，炙杷叶6克，瓜蒌10克，麦冬10克，百部10克，甘草5克，茜草6克，阿胶10克，藕节10克，仙鹤草12克，地骨皮12克，桑叶12克，竹叶6克。6月14日（二诊）：上方服4剂，咳嗽，痰中已无血，晚间咽干，胸痛减轻，头晕愈。下午手烧，腰困，脉沉弱，仍遵上法。方药：桔梗6克，贝母10克，杏仁10克，紫菀10克，橘红6克，炙杷叶6克，瓜蒌仁12克，麦冬10克，百部10克，苏子6克，茜草6克，地骨皮10克，甘草5克，沉香6克，丹皮6克，桑叶10克。6月18日（三诊）；服上方4剂，再未咳血，胸痛好转。只有劳动时觉轻微疼痛。咳痰白粘，咽干，盗汗，小便频数，手烧，腰困。脉仍沉弱。治宜滋补肺肾，化痰止嗽，辅以敛汗。上方改橘红为10克，瓜萎仁10克，地骨皮12克，加辽沙参10克，五味子5克，菟丝子15克，杜仲12克，煅龙骨10克，煅牡蛎10克，浮小麦18克，枸杞子10克，去苏子、杏仁、紫菀、炙杷叶，茜草，沉香，桑叶，水煎服。6月28日（四诊）；上方加减服6剂，胸痛轻微，咳嗽痰少而粘，盗汗止，小便次数减少，但尿时仍痛，手心还烧，腰困。脉沉弱。上方加知母10克，桑叶10克，地骨皮改为21克，继服6剂，诸证渐安。（《张子琳医疗经验选辑》）[评按]咳血系指由肺经气道咳嗽而出，痰血相兼，或痰中带血，或纯血鲜红间夹气泡的病证。多因外感风热燥气或内伤情志，直接或间接伤及肺络所致。
案例一系因肝火犯肺伤及肺络而咳血。肝火偏旺，阴虚火扰，灼伤肺络，故见咳血。肝脉布于两胁，脉络瘀滞，症现胁肋引痛。治以平肝清肺，化痰和络。方用黛蛤散，泻白散加化瘀药，证治较为合拍。方中黛蛤散清肝化痰，泻白散泻肺清热，桃仁、赤芍等活血化瘀，大黄化瘀清热、推陈致新，肝火得平，肺气肃降，瘀热下行。此案见血而不用止血药，咳血能自止者，乃审证、求因、治本三者相结合之妙。
案例二为痰血相兼，或痰中带有血丝、血点。盖肺为娇脏，喜润恶燥，风热燥邪伤肺，则咳痰胶粘不爽，震伤肺中络脉而致咳血。治以祛除外邪，止嗽止血、润肺化痰之法。标本兼顾，构思周密，疗效颇佳。
(十二)吐血
案例一 鲍姓，女。肝脾不和，湿热交蒸，更兼平素善怒，饮食不节，久而邪气聚当胃脘，遂致胃痛发作之时，痛如刀割，脘中燔热，吞酸，满闷，懊侬作吐，有时吐物中伴有血出，大便秘结而黑，舌苔垢腻，经XX医院检查，诊为“十二指肠溃疡”合并“胃出血”，病。脉弦紧而滑，两关位独盛，亟宜镇肝和胃，行气止痛，搜肃湿热以内消之。石决明（生研先煎）24克，青竹茹12克，台乌药9克，盐橘核12克，龙胆草（酒炒）9克，旋复花（布包煎）12克，生赭石12克，藕节?枚，煨粉葛根1.5克，水制甘草1.5克，藿香梗9克，陈皮6克，焦栀子9克，土炒焦白芍4.5克，槟榔炭（醋炒）4.5克，炒枳壳6克，醋军炭4.5克，川郁金（生白矾水浸）9克，苏合香丸1粒（冲服），犀黄丸6克（冲服）。共诊9次，服药21剂，然后改配丸药，服两料后疾病痊愈。（孔嗣伯介绍；孔伯华先生学术经验简介，《中医杂志》7：5，1962）
Background Information
Book: Compilation of Verified Cases by Famous Doctors in Modern Times
Chapter: Main Text (13/53)
Category: Medical Discussion
Case 2 Lu XX, Female, 52 years old. The patient had a history of joint pain. For the past year, she experienced skin pruritus; after scratching, blood spots appeared on the skin, followed by petechiae, predominantly on the limbs and chest/abdomen. In the last three days, gingival bleeding amounted to approximately 2000 ml, with more severe nocturnal hemorrhage. Symptoms included fever, headache, joint pain, and hematuria. Treatment with hemostatics and vitamins failed to control the bleeding. Examination revealed clouded consciousness, gingival bleeding, and scattered petechiae on the limbs and chest. Laboratory tests showed: Hemoglobin 9.5 g, Red Blood Cells 3.96 million/mm³, White Blood Cells 13,500/mm³, Platelets 25,740, Bleeding time >15 min (unstopped), Clotting time 2 min. Pulse was floating, wiry, and rapid; tongue body was red with thin yellow coating. Pattern differentiation: Toxic heat stagnating in the Ying (Nutritive) level, with heat forcing blood extravasation. Treatment principle: Clear heat and detoxify, cool the blood and stop bleeding. Prescription: Jin Yin Hua (Lonicerae Japonicae Flos), Da Qing Ye (Isatidis Folium), Xian Mao Gen (Imperatae Rhizoma), Ou Jie (Nelumbinis Node) each 24g; Lian Qiao (Forsythiae Fructus), Da Ji (Cirsii Japonici Herba), Xiao Ji (Cirsii Herba) each 15g; Dan Pi (Moutan Cortex) 12g; Xian Chang Pu (Acori Tatarinowii Rhizoma), Xian Pei Lan (Eupatorii Herba) each 9g; Huang Lian (Coptidis Rhizoma) 6g; Yin Chai Hu (Stellariae Radix) 4.5g; Xi Jiao Fen (Rhinocerotis Cornu Powder) 1.5g (taken with decoction). Second visit: After taking two doses of the previous prescription, sweating occurred, body heat gradually subsided, gingival bleeding decreased, consciousness cleared, and pulse became wiry and rapid. This indicates that exterior heat has been cleared, but stagnant heat in the Ying level remains undispersed. The method should be clearing the Ying level, cooling blood, and stopping bleeding. Prescription: Xian Mao Gen 20g; Yin Yin Hua, Sheng Di Huang (Rehmanniae Radix), Ou Jie each 24g; Dan Pi, Xian He Cao (Agrimoniae Herba), Gui Ban (Testudinis et Plastrum Carapacis et Plastrum Testudinis), Qian Cao Gen (Rubiae Radix), Da Ji, Xiao Ji each 15g; Zhi Zi (Gardeniae Fructus), Huai Hua (Sophorae Flos), E Jiao (Colla Corii Asini) each 9g; Huang Lian 6g; Xi Jiao Fen 1.5g (taken with decoction). Third visit: After taking five doses of the previous prescription, body heat subsided, gingival bleeding stopped, systemic petechiae were absorbed with no new lesions, and spirit and appetite recovered. Fatigue and weakness persisted, along with occasional palpitations and shortness of breath. Pulse was fine and soft; tongue was pale red. This indicates that heat in the Ying level has been cleared, but Middle Qi is still deficient. The method changes to strengthening the Spleen, nourishing Yin, and stopping bleeding. Prescription: Xian Mao Gen [dose missing], Sheng Di Huang, Gui Ban each 15g; Sheng Shan Yao (Dioscoreae Rhizoma), Hai Piao Xiao (Sepiae Endoconcha), Da Ji, Xiao Ji each 12g; Dan Pi, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Xian He Cao, Qian Cao Gen each 9g; E Jiao 6g; Ren Shen (Ginseng Radix) 3g (taken with decoction). After taking four doses of the above prescription, all symptoms resolved. Blood tests returned to normal. (Selected Cases of Xing Xibo)
Case 3 Zhang XX, Male, 47 years old, Hospital No. 52046, First Visit Date: November 1973. The patient had had bleeding points on the upper and lower limbs and chest for six years. Blood tests and bone marrow examination showed hypoplasia and pancytopenia. A certain hospital diagnosed Aplastic Anemia, complicated by Coronary Heart Disease, Secondary Atrial Fibrillation, and other chronic conditions. Various Chinese and Western medical treatments yielded poor results; over six years, he received over 53,000 ml of blood transfusions. Current symptoms: Dizziness and vertigo, dark complexion, pale and dusky lips and nails, palpitations and fright, insomnia and light sleep, loss of libido, edema of the four limbs, sweating with aversion to cold, shortness of breath and reluctance to speak, soreness and weakness of the waist and legs, distending pain in the hypochondrium, chest fullness and poor appetite, abdominal pain and diarrhea. Pulse was slow, fine, and slippery; coating was thick, white, and greasy. Pattern differentiation: All five Zang organs are diseased, with the key factor being Cold-Dampness encumbering the Spleen. Treatment principle: Bitter-warm to dry dampness, awaken the Spleen and stimulate appetite. Prescription: Pei Lan Ye (Eupatorii Herba) 9g; Su Geng (Perillae Caulis), Huo Geng (Agastachis Rhizoma) each 5g; Cang Zhu (Atractylodis Rhizoma) 10g; Hou Po Hua (Magnoliae Flos) 5g; Sha Ren Ke (Amomi Fructus Rotundus) 5g; Bai Dou Kou (Tsaoko Fructus) 5g; Chen Pi Tan (Citri Reticulatae Pericarpium Carbonisatum) 10g; Dai Dai Hua (Fortunellae Semen) 5g; Fu Ling Pi (Poria Cum Ramis et Cortice) 10g; Lv E Mei (Prunus mume f. viridis Flos) 6g; Jiao Yi Yi Ren (Coeli Semen Preparatum) 12g; Bai Tong Cao (Tetrapanacis Medulla) 5g; Jian Shen Qu (Medicated Leaven) 10g. Adhering to this prescription, 6 doses per week, occasionally adding Wu Zhu Yu (Evodiae Fructus), Gan Jiang (Zingiberis Rhizoma), Fu Pian (Aconiti Lateralis Radix Praeparata) according to symptoms. After about two months of medication, all symptoms decreased, and blood transfusions were stopped. Blood tests approached normal. Continuing with modifications of the above prescription, the patient was discharged on April 1, 1974. Blood picture stabilized. Only dizziness, fatigue, weak pulse, white greasy coating, and pale tongue remained. Cold-Dampness was nearly cleared, but deficiency of Healthy Qi was prominent. The plan was to tonify Qi and strengthen the Spleen, dispel dampness, and stimulate appetite. Prescription: Dang Shen (Codonopsis Radix) 15g, Sheng Huang Qi (Astragali Radix) 15g, Bai Zhu 10g, Yun Fu Ling (Poria) 9g, Chen Pi Tan 9g, Chao Zhi Ke (Aurantii Fructus) 9g, Hou Po Hua 6g, Pei Lan Ye 9g, Sha Ren Ke 5g, Jiao San Xian (Prepared Sanxian) 18g, Dang Gui (Angelicae Sinensis Radix) 10g. 10-20 doses per month. Bone marrow examinations in September 1974 and September 1975 showed near-normal results. Follow-up in October 1980 showed stable blood picture, working full-time for over three years. (Organized by Duan Rongshu, Brief Talk on Medical Experience of Dong Demao, *Chinese Journal of Traditional Medicine* 2:9, 1981)
Case 4 Wang XX, Female, 41 years old. Presented due to oral bleeding accompanied by red spots on the skin for 4 days. Platelet count was 12,000/mm³. Western diagnosis: Primary Thrombocytopenic Purpura. Transferred to our clinic for treatment. Epistaxis like a gush, mouth full of fresh blood, dense red spots and purpura all over the body, timid spirit and sallow complexion, pale lips and nails, dizziness, restless palpitations, dry mouth but no desire to drink, toothache without redness or swelling. Pulse was deep, fine, and powerless; tongue body pale, coating thin white. Pattern differentiation: Deficiency of both Qi and Yin, with Deficient Fire flaming upward. Treatment principle: Tonify Qi to secure blood, nourish Yin and blood, benefit Kidney to anchor Yang, guide fire back to its source. Prescription: Mian Huang Qi (Astragali Radix) 15g, Tai Zi Shen (Pseudoginseng Radix) 9g, Xi Dang Gui (Angelicae Sinensis Radix) 9g, Hang Bai Shao (Paeoniae Radix Alba) 9g, Qing E Jiao (Colla Corii Asini) 6g (melted and added), Huo Ci Shi (Magnetitum) 15g, Mo Han Lian (Ecliptae Herba) 15g, Gou Qi Zi (Lycii Fructus) 9g, Gu Sui Bu (Drynariae Rhizoma) 15g, Chuan Shi Hu (Dendrobii Caulis) 15g, Xue Yu Tan (Hominis Combusta Crinis) 9g (wrapped), Xiao Hong Zao (Jujubae Fructus) 5 pieces (cut open), Pao Jiang Tan (Zingiberis Rhizoma Preparatum Carbonisatum) 1.5g, Zhi Fu Pian (Aconiti Lateralis Radix Praeparata) 3g, Rou Gui Fen (Cinnamomi Cortex Powder) 0.9g (swallowed). This formula is derived from the blood-stopping formulas of Yu Jiayan and Huang Kunzai. If residual fire is not contained, merely tonifying Qi to secure blood, nourishing Yin and blood, benefiting Kidney to anchor Yang will be ineffective. The use of Ginger, Aconite, and Cinnamon in the formula contains residual fire and represents a counter-assistance modification. After taking the medicine, bleeding gradually stopped. After half a month, epistaxis completely ceased, red spots and purpura faded, spirit improved, and platelet count rose to 60,000/mm³. Discharged for rest. Re-examination half a month later showed platelet count rose to 100,000/mm³; medication was stopped. (Experience of Zou Yunxiang, Organized by Huang Xinwu: Application of Counter-Assistance Therapy in Clinical Practice, *New Medicine Magazine* 6:11, 1978)
Case 5 Zhao X, Male. The Classics state: "The Spleen is the foundation of granaries, the residence of Ying." The Spleen is the organ that controls blood. Now Liver Wood attacks it; long-standing dampness injury causes the blood controlled by the Spleen to flow chaotically. Dampness stagnates, mixing clear and turbid, San Jiao Qi transformation is unregulated, four extremities do not respond, filling up above and below. Thus, outside the internal organs, observing various orifices, bleeding is seen everywhere: black stool, red urine, epistaxis, and especially severe gingival bleeding. This relates to "Spleen Qi scatters essence, ascending to return to the Lung," indicating the Spleen-Lung relationship. Flesh wasting away, skin color extremely pale, four extremities and nails lack luster. Tongue crimson, edges scarlet, coating white and greasy. Lips white, not scorched but lacking luster, poor intake, dry mouth without desire to drink, slight afternoon fever and tidal sweating. Pulse wiry, slippery, and rapid; Guan positions particularly large. Reported onset over half a year ago. Western examination diagnosed "Septicemia," multiple treatments failed, condition worsening recently. The case is perilous. Tentatively prescribing clearing and nourishing, anchoring Yang, supporting and strengthening Spleen Earth, seeping out dampness and transforming dryness, diffusing and regulating Qi, assisting Stomach to stop bleeding—a comprehensive approach addressing both root and branch. Die Xue Qing Hao (Artemisiae Annuae Herba prepared with Turtle Blood) 12g, Xue Yu Tan 9g, Xue Hu Po (Succinum Preparatum, decoct first) 6g, Sheng Mu Li (Ostreae Concha, decoct first) 15g, Chi Xiao Dou (Phaseoli Semen Rubrum, wrapped in cloth) 30g, Jiao Gu Dao Ya (Milii Germen Preparatum, Oryzae Germen Preparatum) each 12g, Xuan Fu Hua (Inulae Flos, wrapped in cloth) 9g, Zhen Zhu Mu (Margaritifera Concha, ground and decocted first) 30g, Pu Huang Tan (Typhae Pollen Carbonisatum) 9g, Xian Ou (Nelumbinis Rhizoma) 30g, Xian Mao Gen 30g, Xian Shi Hu (Dendrobii Caulis, decoct first) 30g, Jiao Zhi Zi (Gardeniae Fructus Preparatum) 9g, Sheng Zhe Shi (Haematitum) 9g, Chuan Bai (Phellodendri Chinensis Cortex) 9g, Yin Hua Tan (Lonicerae Japonicae Flos Carbonisatum) 12g, Sheng Hua Shi (Talcum) 15g, Chuan Niu Xi (Cyathulae Radix) 9g, Chuan Yu Jin (Curcumae Radix) 9g, Ling Ci Shi (Magnetitum, raw ground and decocted first) 9g, Wu Xi Jiao Jian (Rhinocerotis Cornu Tip) 0.9g (decocted separately and mixed in), Xi Huang Wan (Calculus Bovis and Realgar Pill) 6g (taken with decoction), decocted with Huang Tu Tang (Yellow Earth Decoction), taken warm twice daily morning and evening. Total 16 visits, over 40 doses, cured. Huang Tu Tang decoction method: Take pure yellow earth (fresh) 120g and about 1000ml clear water, boil in a pot for one hour, then add a little Bai Fan (Alumen) to precipitate. Wait until cool, filter through gauze to obtain clear liquid. Use this yellow earth water to decoct the herbs in a clay pot. (Introduced by Kong Sibai: Brief Introduction to Academic Experience of Mr. Kong Bohua, *Chinese Journal of Traditional Medicine* 7:5, 1962) [Commentary] Nu Xue (Epistaxis/Hemorrhage from orifices) refers to bleeding from nose, gums, ears, tongue, and skin without external trauma. Depending on the site, it is called Bi Nu (Nosebleed), Chi Nu (Gum bleed), She Nu (Tongue bleed), Ji Nu (Skin bleed). Generally, it is slow oozing, but can be massive acute hemorrhage causing blood loss, collapse, or even collapse syndrome. Although distinguishable, clinically it may occur simultaneously with bleeding from other sites.
Case 1 Main symptoms are gum bleeding and nosebleed. Nose is the orifice of the Lung; gums belong to the Stomach collaterals. Excess Heat in Lung and Stomach forcing blood to run wild, or Yin deficiency of Liver and Kidney with Deficient Fire flaming upward damaging collaterals, can all cause Nu Xue. This case belongs to Liver Heat rushing upward and Blood stasis stagnating internally. Treatment: Clear Liver, cool blood, resolve stasis, and eliminate stagnation. Dr. Guo believes: In the progressive stage, this disease mostly belongs to excess heat pattern of Liver Heat and Blood Stasis. Using cold-natured herbs to directly suppress is necessary; bowel movements must be smooth for excess heat to escape for efficacy to be achieved.
Case 2 Pattern is Toxic Heat stagnating in Ying level, heat forcing blood extravasation. Initially using Clear Heat, Detoxify, Cool Blood, Stop Bleeding clears external pathogens and withdraws internal blood heat, like removing firewood from under the cauldron. Then nourishing Yin and clearing Ying; once blood heat is cleared and Ying Yin recovers, adding Spleen-strengthening and Qi-tonifying agents ensures sufficient Middle Qi to control blood, consolidating curative effect.
Case 3 Condition is complex, involving all five Zang organs, but Cold-Dampness encumbering Spleen is most prominent. Dr. Dong treats with bitter-warm drying dampness and awakening Spleen/stimulating appetite. The prescription intends to treat acquired foundation to consolidate primordial origin, regulate Spleen/Stomach to calm five Zang organs, differing significantly from general methods. Medicines are not extraordinary but have extraordinary effects.
Case 4 Epistaxis like a gush, mouth full of fresh blood, red spots and purpura all over. Pattern is Qi and Yin dual damage, Deficient Fire flaming upward. Treatment uses counter-assistance modification: within a large group of Yin-nourishing, blood-tonifying, Qi-tonifying, blood-securing herbs, counter-assisting with Ginger, Cinnamon, Aconite to contain residual fire and guide fire back to source, quite unique.
Case 5 Western diagnosis "Septicemia," clinical presentation "bleeding from seven orifices," multiple treatments failed, condition perilous. Dr. Kong’s treatment thought is meticulous; although methods are complex, execution is agile and structured. Although many herbs, combination is rigorous, addressing both root and branch, achieving good results.
(Eleven) Coughing Blood
Case 1 Li XX, Male, 74 years old: First Visit Date: December 17, 1974. Patient has had coughing blood for over four months. Chest fluoroscopy excluded lung cancer and tuberculosis; mild emphysema existed previously. Currently cough is not severe; two nights ago expectorated over ten mouthfuls of fresh blood, sputum like white foam, sometimes dull pain in left hypochondrium, dry mouth, shortness of breath on exertion, diet and excretion normal. Coating thin, pulse wiry. Pattern differentiation: Liver Fire invading Lung, Lung collaterals injured. Treatment principle: Clear Lung, calm Liver, resolve stasis, harmonize collaterals. Prescription: Xie Bai San combined with Dai Ge San modified. Sang Bai Pi (Mori Cortex) 12g, Di Gu Pi (Lycii Cortex) 12g, Bei Sha Shen (Glehniae Radix) 9g, Xing Ren (Armeniacae Semen Amarum) 9g, Tao Ren (Persicae Semen) 4.5g, Dan Pi 9g, Chi Shao (Paeoniae Radix Rubra) 9g, Zhi Chuan Jun (Rhei Radix et Rhizoma Prepared) 4.5g, Huang Qin (Scutellariae Radix) 9g, Zhi Su Zi (Perillae Fructus Prepared) 12g, Dai Ge San (Indigo Naturalis and Ark Shell Powder) 12g (wrapped for decoction). December 24 (Second Visit): Hemoptysis stopped, hypochondriac pain reduced, sputum difficult to expectorate, appetite normal, coating thin, pulse wiry. Continue Clear Lung, Calm Liver, Nourish Yin, Stabilize Collaterals method. Remove Tao Ren from original prescription, add Gua Lou Pi (Trichosanthis Pericarpium) 9g, Mai Dong (Ophiopogonis Radix) 9g, take another 6 doses. December 31 (Third Visit): No hemoptysis for over ten days, but occasional pulling pain in left hypochondrium, less cough, nasal dryness, excretion normal. Coating thin greasy, pulse wiry. Further prescribe Clearing and Nourishing Qi and Yin, Moistening Lung, Transforming Phlegm to conclude treatment. Bei Sha Shen 9g, Sang Bai Pi 9g, Di Gu Pi 9g, Huang Qin 9g, Xing Ren 9g, Dong Gua Zi (Benincasae Semen) 12g, Si Gua Luo (Luffae Retinervia) 6g, Chi Shao 9g, Zhi Yuan Zhi (Polygalae Radix Prepared) 4.5g. (Yellow Wendong's Medical Cases)
Case 2 Tian XX, Male, 27 years old, First Visit Date: June 10, 1976. Cough, expectorating white sticky sputum. Suddenly coughed blood ten days ago, mouth full of blood. Subsequently sputum contained blood spots and threads. Sometimes sputum and blood mixed. Dry mouth, dry throat, occasional chest pain. Tongue body red, scant coating, pulse deep, rate normal. Pattern differentiation: Lung Qi failing to diffuse, cough injuring Lung collaterals. Treatment principle: Diffuse Lung, transform phlegm, regulate Qi, stop bleeding. Prescription: Jie Geng (Platycodonis Radix) 6g, Bei Mu (Fritillariae Bulbus) 10g, Zi Wan (Asteris Radix) 10g, Ju Hong (Citri Reticulatae Pericarpium) 6g, Zhi Pa Ye (Eriobotryae Folium Prepared) 6g, Gua Lou (Trichosanthis Fructus) 10g, Mai Dong 10g, Bai Bu (Stemonae Radix) 10g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 5g, Qian Cao (Rubiae Radix) 6g, E Jiao 10g, Ou Jie 10g, Xian He Cao 12g, Di Gu Pi 12g, Sang Ye (Mori Folium) 12g, Zhu Ye (Bambusae Folium) 6g. June 14 (Second Visit): Took 4 doses of above prescription; cough and blood in sputum stopped, nocturnal dry throat and chest pain relieved, dizziness cured. Afternoon hand burning, waist fatigue, pulse deep and weak. Still follow previous method. Prescription: Jie Geng 6g, Bei Mu 10g, Xing Ren 10g, Zi Wan 10g, Ju Hong 6g, Zhi Pa Ye 6g, Gua Lou Ren (Trichosanthis Semen) 12g, Mai Dong 10g, Bai Bu 10g, Su Zi (Perillae Fructus) 6g, Qian Cao 6g, Di Gu Pi 10g, Gan Cao 5g, Chen Xiang (Aquilariae Lignum Resinatum) 6g, Dan Pi 6g, Sang Ye 10g. June 18 (Third Visit): Took 4 doses, no more hemoptysis, chest pain improved. Only slight pain during labor. Expectorating white sticky sputum, dry throat, night sweats, frequent urination, hand burning, waist fatigue. Pulse still deep and weak. Treatment suitable: Nourish Lung and Kidney, transform phlegm, stop cough, assist in arresting sweating. Modify above prescription: Ju Hong to 10g, Gua Lou Ren to 10g, Di Gu Pi to 12g, add Liao Sha Shen (Glehniae Radix) 10g, Wu Wei Zi (Schisandrae Fructus) 5g, Tu Si Zi (Cuscutae Semen) 15g, Du Zhong (Eucommiae Cortex) 12g, Duan Long Gu (Fossilia Ossis Maxillaris Preparatum) 10g, Duan Mu Li 10g, Fu Xiao Mai (Tritici Semen Leve) 18g, Gou Qi Zi 10g. Remove Su Zi, Xing Ren, Zi Wan, Zhi Pa Ye, Qian Cao, Chen Xiang, Sang Ye. Decoct in water. June 28 (Fourth Visit): Modified prescription taken for 6 doses, slight chest pain, less cough and sticky sputum, night sweats stopped, urination frequency reduced, but pain during urination persists, palms still hot, waist fatigue. Pulse deep and weak. Add Zhi Mu (Anemarrhenae Rhizoma) 10g, Sang Ye 10g, change Di Gu Pi to 21g, continue 6 doses, all symptoms gradually settled. (Selected Medical Experience of Zhang Zilin) [Commentary] Ke Xue (Coughing Blood) refers to blood coughed out via the airway of the Lung meridian, mixed with sputum, or containing blood in sputum, or pure bright red blood interspersed with bubbles. Mostly caused by external contraction of Wind-Heat-Dryness or internal emotional injury, directly or indirectly damaging Lung collaterals.
Case 1 Due to Liver Fire invading Lung and damaging Lung collaterals causing hemoptysis. Liver Fire hyperactive, Yin deficiency disturbing fire, scorching Lung collaterals, hence hemoptysis. Liver meridian distributes in hypochondrium; collateral stasis presents as pulling pain in ribs/flanks. Treatment: Calm Liver, Clear Lung, transform phlegm, harmonize collaterals. Formula uses Dai Ge San, Xie Bai San plus blood-activating drugs. Case treatment matches pattern well. Dai Ge San clears Liver and transforms phlegm; Xie Bai San drains Lung and clears heat; Tao Ren, Chi Shao etc. activate blood and resolve stasis; Da Huang (Rhei Radix et Rhizoma) resolves stasis, clears heat, pushes out old and generates new. Liver Fire calmed, Lung Qi descends, stasis-heat moves downward. In this case, seeing blood but not using hemostatic drugs allows hemoptysis to stop spontaneously; this is the subtlety of combining pattern investigation, etiology seeking, and root treatment.
Case 2 Sputum and blood mixed, or sputum containing blood threads/spots. Lung is a delicate organ, preferring moisture and disliking dryness. Wind-Heat-Dryness pathogen injuring Lung makes sputum sticky and difficult to expectorate, shaking Lung collaterals causing hemoptysis. Treatment: Expel external pathogens, stop cough and bleeding, moisten Lung and transform phlegm. Addressing both root and branch, careful conception, excellent efficacy.
(Twelve) Vomiting Blood
Case 1 Surname Bao, Female. Liver-Spleen disharmony, Damp-Heat steaming and intermingling, plus habitual anger and irregular diet. Over time, pathogenic factors gather at the stomach region, causing stomach pain attacks, cutting-like pain, burning sensation in epigastrium, acid regurgitation, fullness, distress, retching/vomiting, sometimes vomitus contains blood, constipation with black stool, coating greasy. Examined at XX Hospital, diagnosed as "Duodenal Ulcer" complicated by "Gastric Hemorrhage". Pulse wiry, tight, and slippery; Guan positions particularly strong. Urgently need to pacify Liver, harmonize Stomach, move Qi, relieve pain, search and肃 (cleanse) Damp-Heat to dissipate internally. Shi Jue Ming (Haliotidis Concha, raw ground and decocted first) 24g, Qing Zhu Ru (Bambusae Sapta Preparatum) 12g, Tai Wu Yao (Linderae Radix) 9g, Yan Ju He (Citri Reticulatae Semen) 12g, Long Dan Cao (Gentianae Radix, wine-fried) 9g, Xuan Fu Hua 12g (wrapped), Sheng Zhe Shi (Haematitum) 12g, Ou Jie ? pieces, Wei Fen Ge Gen (Puerariae Radix Preparatum) 1.5g, Shui Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Water-processed) 1.5g, Huo Xiang Geng (Agastachis Caulis) 9g, Chen Pi 6g, Jiao Zhi Zi 9g, Tu Chao Jiao Bai Shao (Paeoniae Radix Alba Soil-fried) 4.5g, Bing Lang Tan (Arecae Semen Carbonisatum, vinegar-fried) 4.5g, Chao Zhi Ke 6g, Cu Jun Tan (Rhei Radix et Rhizoma Vinegar-carbonised) 4.5g, Chuan Yu Jin (Curcumae Radix, soaked in Alum water) 9g, Su He Xiang Wan (Styrax Pill) 1 pill (taken with decoction), Xi Huang Wan 6g (taken with decoction). Total 9 visits, 21 doses, then switched to pills, took two batches, disease cured. (Introduced by Kong Sibai: Brief Introduction to Academic Experience of Mr. Kong Bohua, *Chinese Journal of Traditional Medicine* 7:5, 1962)