又治李某某，女，３５岁。某年暑月感冒后发热，服解表药热势减轻，下肢忽出现紫癜数处，适值月信将至，延医诊治，以为此属血瘀特征，连进芎、归、桃、红等活血祛瘀药数剂后，经血大至如崩，口鼻亦见衄血，全身紫癜增多。急来邀诊：视其舌质红绛，脉象细数，断为血虚而伏有内热，冲激阳络，使血外溢，导致全身出血，是名大衄。所现紫癜，即是血热明显特征，与折跌打第三卷２２８伤局部仅有青紫斑块而当从瘀血论治者不同。芎归辛温，不可施用于血热之证；而活血逐瘀之药，用于此证，更是南辕北辙，能促使血液外溢，而造成危证。此时救治之法，拟以凉营清热育阴止血为主。方用犀角地黄汤加炒黄芩、仙鹤草、茅根、阿胶、蒲黄炭、乌贼骨、血余炭、茜草根炭、藕节等药，大剂煎服。连进三大剂后，再诊：患者热势退净，紫癜渐少，衄血渐止。前方去犀角，仍以清热育阴凉血止血法以善后，而病痊愈。
四、痧病证治漫谈古无痧字。后世中医学中，用作病名，约有三义：一即俗谓绞肠痧、瘪螺痧者，盖霍乱病之状态；二即俗谓烂喉痧，咽喉白，烂，肌肤发现红点，即所谓猩红热是也；三是外感风热，身现红粒搔痒如麻疹者，俗亦呼曰痧子，其证较轻微，发于小儿者居多（说见于《中华大字典》）。惟本文所谈痧病，是在此三说之外。其病或曰发痧，或曰痧胀，或称痧病，当是麦收之际，在吾鄂大江南北，江汉平原地区，最容易出现的一种常见急性疾病。宋·张季明云：“沙病，江南旧无，今东西皆有之，原其证医家不载，大凡才觉寒似伤寒而状似疟，但觉头痛，浑身壮热，手足厥冷”（《医说·卷三·辨沙病》）者是也。清·郭石陶《痧胀玉衡》一书，专论此病，惟内容太繁，治法亦未尽善，难以掌握要领，反令人无所适从。
痧病的发病原因与病理机制：此病多由患者暑月饮食不洁，或饮冷太过，或食物失节，或彻夜贪凉露宿，内外合邪，一时中焦肠胃升降失序，气机偶愆，以致胸中大气不得转旋，营卫气血流行于周身脉络被阻，故呈眩冒欲绝，四肢发麻，手足厥冷，口、唇、爪甲青紫，周身难过，俨如痧胀不舒之典型症状。亦有伴见头痛、寒栗壮热者。更重者并有欲吐不得吐、欲泻不得泻，或腹痛，呈所谓“干霍乱”之症状。按：沙字，从水少，水少石见，段玉裁谓“石散碎谓之沙”。此痧字当由沙字衍化而来，故《医说》辨此为沙病，可为一证。民间借痧字作此病病名，实与痧病病况，大致相合。
痧病治法：大抵分为外治法与内治法两种。因痧病起病急骤，一般采取急救方法，通常以外治法为主。外治法：（１）刮法：外用刮法最妙。重点在脊骨全部及两肘弯、两膝弯等处。刮时以手指持康熙青铜钱蘸青油或薄荷油由上而下，由轻而重，从容施行，以刮后皮肤带红紫色为好。刮法能令病邪宣畅，脉络通达，气血流行，反复进行，最为有利无弊。（２）吹鼻取嚏法：用卧龙丹或开关散（以上均为成药）吹鼻取嚏。如无以上成药，只用细辛、猪牙皂角二味少许碾为细末，吹鼻取嚏。功能开闭通窍，促使气机流通，有助于病势向好的方面转化。（３）出血法：用三棱针或瓷针针刺尺泽、委中或十宣、舌尖及舌下两大青筋处出血。施术前针头及针刺部位，宜用棉花蘸酒精进行严密消毒。出血法能疏导病邪，流通气血。但出血量不可太多，只以见少许为宜。（４）掐法：用手指掐肩、背、腰部各大筋肌腱处，可令其气血流行，脉络宣通，有助于病势缓解。但掐时不可作强大刺激，只以患者有痛感为度。（５）探吐法：适用于欲吐不得吐、欲泻不得泻呈所谓干霍乱之症状者。治法当因势利导，可用烧盐汤或白鹅翎探喉取吐，以宣畅气机为宜。（６）其他中医药急救法：如诸葛行军散、太乙紫金丹等成药，既可外治，又可内服，医者或病家皆可备用。至于内服方药，治法总以宣郁开闭疏畅气机为主。李氏常用藿香正气散合香苏散加减化裁，结合外治法处理，对于痧病，有一定的效果。用药如藿香、佩兰、枇杷叶、紫苏、香附、橘红、乌药、炒枳实、大腹皮、厚朴、法半夏、茯苓、炒建曲等。亦有痧病经外治法处理病势已第三卷２２９平之后，可以勿药告愈者。至于禁忌，最忌滥用参、芪、白术等壅补滞气药及妄施攻下如硝、黄类寒下之类。又本病虽见爪甲青紫，肢麻厥冷，但病机总属闭证一类，与休克虚脱证象有别。
《医说》云：“乡落多用艾灸，以得砂为良，有因灸脓血迸流移时而死者”，不可不知。曩昔李氏在本乡开业应诊时，每年夏秋之际，接触此病患者甚多。细询得病原因，多缘于习惯性饮冷贪凉。遂劝其禁饮未经煮沸之水，即或暑月大热，习惯露宿，亦令以薄被覆盖腹部。故乡间有所谓“痧路子”之体（即每年容易患痧病者），听从此说，至今多年未发此病，可以说明防重于治的重要性。
痧病，明·江篁南《名医类案》认为即是《内经》之“解”。此在清·魏玉横校订《类案》时，其友人与魏氏书（未署名。此书又见于清代学者杭世骏《道古堂集》，当是杭氏所撰，亦即为《名医类案》作序者），直訾其误，道理极是。惟云去痧病为“小小疾苦”，似不尽然。盖曾见民间有患痧病而危及生命者，不乏其例。其书辨“解”，能综合经旨，旁参注说，立论颇精，值得一读。
兹特摘录于后，不仅可供对痧病医史文献研究者之参考，而对学习《内经》者，亦当有所一助耳。
附录：与魏玉横论解亻亦书“解”二字，不见他书，解即懈，者亦。倦而支节不能振耸，惫而精气不能检摄，筋不束骨，脉不从理，解解，不可指明，非百病中有此一证也。《内经》言此者凡五：《平人气象论》云：“尺脉缓涩，谓之解。”王氏注：“不可名，缓困弱也。”《玉机真藏论》云：“冬脉太过，则令人解。”此从脉起也。《刺疟论》云：“足少阳之疟，令人身体解寒不甚，热不甚，恶见人，见人心惕惕然，多汗出甚。”此从疟起见也。《刺要论》云：“刺骨无伤髓，髓伤则销铄酸，体解然不去矣。”《四时刺逆从论》云：“夏刺经脉，血气乃竭，令人解。”此从刺而究其极也。要皆从四末以起见，如经所言堕怠，小变其词，而意较微渺尔。后世传注与经发明者又有二：《风论》云：“使人不能食，名曰寒热。”，全元起本作失味，皇甫谧《甲乙经》作“解，则即解之渐也。”《至真要大论》云：“发不远热，无犯温凉。”王氏注：不发汗以夺盛阳，则热内淫于四肢而为解，不可名也。粗工呼为鬼气，要病久久不已，则骨热髓涸齿干，乃为骨热病。此又究极解之流弊。所谓救病于已形也。篁南江氏辑《名医类案》，引叶氏《录验方》以为俗名发痧之证，于瘟疫大头天行之后，另列一门，武断极矣。发痧余尝有此证，发必神思躁扰，少腹痛，《灵》《素》未尝言及，特小小患苦耳，与解之义，毫不干涉。篁南父子负盛名而《内经》不识，庸医祖述其说，转以欺世，事无害而理则大谬矣。足下续案已成，删去此门，庶为稳恰，勿令人有误解《内经》之诮，荛言或可采也。
五、谈晶疒立口与枯疒立口证治叶天士《温热论》，于温病卫气营血的辨证，风温、湿温的鉴别以及辨斑疹、验舌、验齿等，均在前人的理论基础上经过临床实践加以总结，对于常见的、多发的温热病辨治，确有指导意义。
特别是书中所说的白，似为叶氏所首倡，能言人所未言，发人所未发。依《温热论》之说“再有一种白小粒如水晶色者，此湿热伤肺，邪虽出而气液枯，必得甘药补之；或未至久延，伤及气液，乃湿郁卫分，汗出不彻之故，当理气分之邪。或白如枯骨者凶，为气液竭也。”现据愚亲身治疗此病之经验，谈谈其体会于下。
第三卷２３０按白之如水晶色者，叫做晶；若白如枯骨者，叫做枯。白多见于夏秋之间湿热正盛之际，天之热气下灼，地之湿气上腾，湿郁热蒸最易使人感受致病。特别是吾鄂大江南北、江汉平原地区，此病最多。初起其症多有微寒发热，汗出胸痞，舌白黄而带滑腻，口虽干而不思饮，腹部感胀而不爽，大便微溏而不快利，纳谷乏味，小溲短黄，脉濡数。治则当参照治湿热之法，分三焦辨治。用药如宣上用藿香叶、佩兰叶、枇杷叶、杏仁、薄荷、鲜荷叶；宽中用厚朴、炒枳壳、橘红、大腹皮、香橼皮；导下如六一散、赤茯苓、薏苡仁、通草梗、车前草之属。至于加减之法，如热盛则加黄芩、竹叶；湿重则加苍术、防己；呕吐则加半夏、白蔻仁；食滞宜加炒建曲、炒麦芽、炒谷芽等。进药二三剂之后，使湿得淡渗以下泄，热得辛宣而外达，则久郁于气分之邪，可从卫分而外达于皮腠，故颈下、胸胁或腹部出现有白如水晶色。病邪既得透达，如是热退神爽，邪热已去，一般可以告愈。亦有湿热羁延难解，白出后，热不退净，用药频与清宣疏达而病邪外透，白续出，热始净，病方愈者。若叶氏所云，湿热久延，伤及气液，必得甘药补之。循叶著所指似是养胃阴一法。然从临床实际考之，尚未用过。因湿热一证，治法最宜宣化而忌滋润，宜疏通而忌呆滞，虽在邪净病退之后，此点亦须注意。也有夏秋之际，常人中间有出现晶者，证无发热，当是湿蒸热郁感受之轻证，自属无关紧要。至于吴鞠通《温病条辨》用薏苡仁竹叶散（竹叶、薏苡仁、滑石、蔻仁、连翘、茯苓、通草）辛凉淡法，以治“湿郁经脉，身热身痛，汗多自利，胸腹白疹，内外合邪”之证。所谓白疹，当是白如水晶色者。所云“纯辛走表，纯苦清热，皆在所忌”，亦是阅历有得之言。惟此方对湿蒸热郁而身热下利出现白之证，药力尚嫌太轻，恐不足以胜病。
若白如枯骨者，叶氏断为“多凶”。汪谢城云，“非惟不能救，并不及救”，自是事实。因忆某年夏，索河某某堂药店吴某之弟，年２０余，患湿温，纠缠多日不解，吴邀会诊，至则视病人舌紫如猪肝色，脉至如雀啄，两手撮空，神识时明时昧，时发谵语，而热势起病至今，未曾减轻。审视其颈下、胸胁等部，有白如枯骨之数十粒。愚曰：此是湿热久延之坏证。邪未透泄，正已大伤，故脉证出现此种败象，并已见有枯。前人虽有气竭之说法，揆其语意，似当治用甘凉以滋养气液。然病势到此危险阶段，恐亦难以回生。未及服药，寻即告殁。然证现枯，鄙见间有可救，故仍当综合全部证候细心辨治，竭力图维，不可一概认为必死者。如治丁姓妇，年龄４０岁。素有漏红之疾，某年秋，感温发热，服清解药二剂后，血忽暴下如崩。邀诊：见其神情极度疲惫，而又心烦不寐，语言恍惚，答非所问。舌质淡白，脉象虚细。诊时血虽少止，仍渗漏而下。
审视心下、胸胁等部，发现枯多粒。幸热势减退，当属不幸中之大幸。针对当前主要症状，治法当以崩漏为主，拟用调养心脾止漏固下之法治之。遂用大剂归脾汤加阿胶、乌贼骨、茜草根炭、炒白芍、血余炭。服药三剂后，漏红已止，惟精神大疲。后仍用小剂归脾汤加减调理数月，方始康复。愈后全身毛发皆脱落殆尽，是枯之仅见治愈者。
六、缪仲淳吐血三要法小议缪仲淳治吐血三要法，其一曰：“宜行血不宜止血”。“血不行经络者，气逆上壅也。行血则血循经络，不止自止。止之则血凝，血凝则发热，恶食，病日痼矣”。吐血之来，见有只吐一二口而止者；有来势颇急倾碗盈盂而吐者；亦有始吐数口继而大吐者。故治法根据证情，针对病势，当以止血为第一要着。盖血止虽有宿瘀而尚徐可图治；若血出不止，则血竭气越，顷刻可以告第三卷２３１危。止血之法，旧传通用之方有花蕊石散、十灰散。愚遇火热上扰阳络受损之吐衄失血诸证，通常采用十灰散（大蓟、小蓟、柏叶、荷叶、茜根、茅根、山栀、丹皮、大黄、棕榈皮各烧灰存性，食远服２０～３０克，童便调下。亦可用大黄醋炒、山栀、丹皮、柏叶、茜根、茅根，煎汤，大剂频服）凉血止血，均有一定的疗效。曾治堂弟李某某，体素弱，因暑月受热而患吐血，视其面赤心烦，畏热口干，舌红脉数，断为血热妄行之证。急用生地６０克、醋炒大黄炭１２克，浓煎、频服，血即顿止，后未复发。盖生地、大黄并用，甘凉复以苦寒，清热止血而不凝瘀，药味单捷而取效速，是古方之配伍精妙处。若花蕊石出硫磺矿中，品质不纯，尚不敢对吐血重证病人，贸然试用。如间遇气虚夹寒而不摄血者，致发吐血，则可采用温中暖寒益气摄血之法。方用归脾汤合《金匮》柏叶汤（余用此方，以干姜炮用，柏叶、艾叶炒黑存性用，另马通一味，则易以童便合服），殊有良效。又遇素有溃疡患者而发吐血者，则用和胃止血法，常以乌贼骨、白芨、茜根、广三七等，炒为末，山药汤调下。此证大量吐血，气虚防脱，则加人参，亦可用米饮调下，每能收到止血的效果。
以上血证若误用行血祛瘀药，不救。
又治疗李某某，女性，35岁。某年暑月（夏季）感冒后出现发热，服用解表药（发散表邪的药物）后热势减轻，下肢突然出现几处紫癜（皮下出血形成的紫色斑点），正值月经将至，延请医生诊治，认为这属于血瘀（血液运行不畅或停滞）的特征，连续服用川芎、当归、桃仁、红花等活血祛瘀药数剂后，经血量大增如崩漏（非经期大量阴道出血），口鼻也出现衄血（鼻出血等非外伤性出血），全身紫癜增多。急忙来邀请诊治：观察其舌质红绛（深红色），脉象细数（脉搏细弱且频率快），判断为血虚而潜伏有内热，冲激阳络（分布于体表上部的脉络），使血液外溢，导致全身出血，这名叫大衄。所出现的紫癜，即是血热（体内热邪炽盛迫血妄行）的明显特征，与《折跌打第三卷228》中记载的因跌打损伤局部仅有青紫斑块而当从瘀血论治者不同。川芎、当归性味辛温，不可施用于血热之证；而活血逐瘀的药物，用于此证，更是南辕北辙（行动和目的相反），能促使血液外溢，而造成危重证候。此时救治之法，拟定以凉营清热（清解营分热邪）、育阴止血为主。方用犀角地黄汤加炒黄芩、仙鹤草、白茅根、阿胶、蒲黄炭、乌贼骨、血余炭、茜草根炭、藕节等药物，大剂量煎服。连续服用三大剂后，再诊：患者热势退净，紫癜渐少，衄血渐止。前方去掉犀角，仍以清热育阴凉血止血法以善后，病痊愈。
四、痧病证治漫谈古无“痧”字。后世中医学中，用作病名，约有三义：一即俗谓绞肠痧、瘪螺痧者，盖霍乱病之状态；二即俗谓烂喉痧，咽喉腐烂，肌肤发现红点，即所谓猩红热是也；三是外感风热，身现红粒搔痒如麻疹者，俗亦呼曰痧子，其证较轻微，发于小儿者居多（说见于《中华大字典》）。惟本文所谈痧病，是在此三说之外。其病或曰发痧，或曰痧胀，或称痧病，当是麦收之际，在吾鄂大江南北，江汉平原地区，最容易出现的一种常见急性疾病。宋·张季明云：“沙病，江南旧无，今东西皆有之，原其证医家不载，大凡才觉寒似伤寒而状似疟，但觉头痛，浑身壮热，手足厥冷”（《医说·卷三·辨沙病》）者是也。清·郭石陶《痧胀玉衡》一书，专论此病，惟内容太繁，治法亦未尽善，难以掌握要领，反令人无所适从。
痧病的发病原因与病理机制：此病多由患者暑月饮食不洁，或饮冷太过，或食物失节，或彻夜贪凉露宿，内外合邪，一时中焦肠胃升降失序，气机偶愆，以致胸中大气不得转旋，营卫气血流行于周身脉络被阻，故呈眩冒欲绝，四肢发麻，手足厥冷，口、唇、爪甲青紫，周身难过，俨如痧胀不舒之典型症状。亦有伴见头痛、寒栗壮热者。更重者并有欲吐不得吐、欲泻不得泻，或腹痛，呈所谓“干霍乱”之症状。按：沙字，从水少，水少石见，段玉裁谓“石散碎谓之沙”。此痧字当由沙字衍化而来，故《医说》辨此为沙病，可为一证。民间借痧字作此病病名，实与痧病病况，大致相合。
痧病治法：大抵分为外治法与内治法两种。因痧病起病急骤，一般采取急救方法，通常以外治法为主。外治法：（１）刮法：外用刮法最妙。重点在脊骨全部及两肘弯、两膝弯等处。刮时以手指持康熙青铜钱蘸青油或薄荷油由上而下，由轻而重，从容施行，以刮后皮肤带红紫色为好。刮法能令病邪宣畅，脉络通达，气血流行，反复进行，最为有利无弊。（２）吹鼻取嚏法：用卧龙丹或开关散（以上均为成药）吹鼻取嚏。如无以上成药，只用细辛、猪牙皂角二味少许碾为细末，吹鼻取嚏。功能开闭通窍，促使气机流通，有助于病势向好的方面转化。（３）出血法：用三棱针或瓷针针刺尺泽、委中或十宣、舌尖及舌下两大青筋处出血。施术前针头及针刺部位，宜用棉花蘸酒精进行严密消毒。出血法能疏导病邪，流通气血。但出血量不可太多，只以见少许为宜。（４）掐法：用手指掐肩、背、腰部各大筋肌腱处，可令其气血流行，脉络宣通，有助于病势缓解。但掐时不可作强大刺激，只以患者有痛感为度。（５）探吐法：适用于欲吐不得吐、欲泻不得泻呈所谓干霍乱之症状者。治法当因势利导，可用烧盐汤或白鹅翎探喉取吐，以宣畅气机为宜。（６）其他中医药急救法：如诸葛行军散、太乙紫金丹等成药，既可外治，又可内服，医者或病家皆可备用。至于内服方药，治法总以宣郁开闭疏畅气机为主。李氏常用藿香正气散合香苏散加减化裁，结合外治法处理，对于痧病，有一定的效果。用药如藿香、佩兰、枇杷叶、紫苏、香附、橘红、乌药、炒枳实、大腹皮、厚朴、法半夏、茯苓、炒建曲等。亦有痧病经外治法处理病势已平之后，可以勿药告愈者。至于禁忌，最忌滥用参、芪、白术等壅补滞气药及妄施攻下如硝、黄类寒下之类。又本病虽见爪甲青紫，肢麻厥冷，但病机总属闭证一类，与休克虚脱证象有别。
《医说》云：“乡落多用艾灸，以得砂为良，有因灸脓血迸流移时而死者”，不可不知。曩昔李氏在本乡开业应诊时，每年夏秋之际，接触此病患者甚多。细询得病原因，多缘于习惯性饮冷贪凉。遂劝其禁饮未经煮沸之水，即或暑月大热，习惯露宿，亦令以薄被覆盖腹部。故乡间有所谓“痧路子”之体（即每年容易患痧病者），听从此说，至今多年未发此病，可以说明防重于治的重要性。
痧病，明·江篁南《名医类案》认为即是《内经》之“解㑊”。此在清·魏玉横校订《类案》时，其友人与魏氏书（未署名。此书又见于清代学者杭世骏《道古堂集》，当是杭氏所撰，亦即为《名医类案》作序者），直訾其误，道理极是。惟云去痧病为“小小疾苦”，似不尽然。盖曾见民间有患痧病而危及生命者，不乏其例。其书辨“解㑊”，能综合经旨，旁参注说，立论颇精，值得一读。
兹特摘录于后，不仅可供对痧病医史文献研究者之参考，而对学习《内经》者，亦当有所一助耳。
附录：与魏玉横论解㑊书“解㑊”二字，不见他书，解即懈，㑊者亦。倦而支节不能振耸，惫而精气不能检摄，筋不束骨，脉不从理，解解㑊㑊，不可指明，非百病中有此一证也。《内经》言此者凡五：《平人气象论》云：“尺脉缓涩，谓之解㑊。”王氏注：“不可名，缓困弱也。”《玉机真藏论》云：“冬脉太过，则令人解㑊。”此从脉起也。《刺疟论》云：“足少阳之疟，令人身体解㑊寒不甚，热不甚，恶见人，见人心惕惕然，多汗出甚。”此从疟起见也。《刺要论》云：“刺骨无伤髓，髓伤则销铄酸，体解㑊然不去矣。”《四时刺逆从论》云：“夏刺经脉，血气乃竭，令人解㑊。”此从刺而究其极也。要皆从四末以起见，如经所言堕怠，小变其词，而意较微渺尔。后世传注与经发明者又有二：《风论》云：“使人不能食，名曰寒热。”，全元起本作失味，皇甫谧《甲乙经》作“解㑊，则即解㑊之渐也。”《至真要大论》云：“发不远热，无犯温凉。”王氏注：不发汗以夺盛阳，则热内淫于四肢而为解㑊，不可名也。粗工呼为鬼气，要病久久不已，则骨热髓涸齿干，乃为骨热病。此又究极解㑊之流弊。所谓救病于已形也。篁南江氏辑《名医类案》，引叶氏《录验方》以为俗名发痧之证，于瘟疫大头天行之后，另列一门，武断极矣。发痧余尝有此证，发必神思躁扰，少腹痛，《灵》《素》未尝言及，特小小患苦耳，与解㑊之义，毫不干涉。篁南父子负盛名而《内经》不识，庸医祖述其说，转以欺世，事无害而理则大谬矣。足下续案已成，删去此门，庶为稳恰，勿令人有误解《内经》之诮，荛言或可采也。
五、谈晶疒立口与枯疒立口证治叶天士《温热论》，于温病卫气营血的辨证，风温、湿温的鉴别以及辨斑疹、验舌、验齿等，均在前人的理论基础上经过临床实践加以总结，对于常见的、多发的温热病辨治，确有指导意义。
特别是书中所说的白疒立口，似为叶氏所首倡，能言人所未言，发人所未发。依《温热论》之说“再有一种白疒立口小粒如水晶色者，此湿热伤肺，邪虽出而气液枯，必得甘药补之；或未至久延，伤及气液，乃湿郁卫分，汗出不彻之故，当理气分之邪。或白如枯骨者凶，为气液竭也。”现据愚亲身治疗此病之经验，谈谈其体会于下。
按白疒立口之如水晶色者，叫做晶疒立口；若白如枯骨者，叫做枯疒立口。白疒立口多见于夏秋之间湿热正盛之际，天之热气下灼，地之湿气上腾，湿郁热蒸最易使人感受致病。特别是吾鄂大江南北、江汉平原地区，此病最多。初起其症多有微寒发热，汗出胸痞，舌白黄而带滑腻，口虽干而不思饮，腹部感胀而不爽，大便微溏而不快利，纳谷乏味，小溲短黄，脉濡数。治则当参照治湿热之法，分三焦辨治。用药如宣上用藿香叶、佩兰叶、枇杷叶、杏仁、薄荷、鲜荷叶；宽中用厚朴、炒枳壳、橘红、大腹皮、香橼皮；导下如六一散、赤茯苓、薏苡仁、通草梗、车前草之属。至于加减之法，如热盛则加黄芩、竹叶；湿重则加苍术、防己；呕吐则加半夏、白蔻仁；食滞宜加炒建曲、炒麦芽、炒谷芽等。进药二三剂之后，使湿得淡渗以下泄，热得辛宣而外达，则久郁于气分之邪，可从卫分而外达于皮腠，故颈下、胸胁或腹部出现有白疒立口如水晶色。病邪既得透达，如是热退神爽，邪热已去，一般可以告愈。亦有湿热羁延难解，白疒立口出后，热不退净，用药频与清宣疏达而病邪外透，白疒立口续出，热始净，病方愈者。若叶氏所云，湿热久延，伤及气液，必得甘药补之。循叶著所指似是养胃阴一法。然从临床实际考之，尚未用过。因湿热一证，治法最宜宣化而忌滋润，宜疏通而忌呆滞，虽在邪净病退之后，此点亦须注意。也有夏秋之际，常人中间有出现晶疒立口者，证无发热，当是湿蒸热郁感受之轻证，自属无关紧要。至于吴鞠通《温病条辨》用薏苡仁竹叶散（竹叶、薏苡仁、滑石、蔻仁、连翘、茯苓、通草）辛凉淡法，以治“湿郁经脉，身热身痛，汗多自利，胸腹白疹，内外合邪”之证。所谓白疹，当是白疒立口如水晶色者。所云“纯辛走表，纯苦清热，皆在所忌”，亦是阅历有得之言。惟此方对湿蒸热郁而身热下利出现白疒立口之证，药力尚嫌太轻，恐不足以胜病。
若白如枯骨者，叶氏断为“多凶”。汪谢城云，“非惟不能救，并不及救”，自是事实。因忆某年夏，索河某某堂药店吴某之弟，年２０余，患湿温，纠缠多日不解，吴邀会诊，至则视病人舌紫如猪肝色，脉至如雀啄，两手撮空，神识时明时昧，时发谵语，而热势起病至今，未曾减轻。审视其颈下、胸胁等部，有白如枯骨之疒立口数十粒。愚曰：此是湿热久延之坏证。邪未透泄，正已大伤，故脉证出现此种败象，并已见有枯疒立口。前人虽有气竭之说法，揆其语意，似当治用甘凉以滋养气液。然病势到此危险阶段，恐亦难以回生。未及服药，寻即告殁。然证现枯疒立口，鄙见间有可救，故仍当综合全部证候细心辨治，竭力图维，不可一概认为必死者。如治丁姓妇，年龄４０岁。素有漏红之疾，某年秋，感温发热，服清解药二剂后，血忽暴下如崩。邀诊：见其神情极度疲惫，而又心烦不寐，语言恍惚，答非所问。舌质淡白，脉象虚细。诊时血虽少止，仍渗漏而下。
审视心下、胸胁等部，发现枯疒立口多粒。幸热势减退，当属不幸中之大幸。针对当前主要症状，治法当以崩漏为主，拟用调养心脾止漏固下之法治之。遂用大剂归脾汤加阿胶、乌贼骨、茜草根炭、炒白芍、血余炭。服药三剂后，漏红已止，惟精神大疲。后仍用小剂归脾汤加减调理数月，方始康复。愈后全身毛发皆脱落殆尽，是枯疒立口之仅见治愈者。
六、缪仲淳吐血三要法小议缪仲淳治吐血三要法，其一曰：“宜行血不宜止血”。“血不行经络者，气逆上壅也。行血则血循经络，不止自止。止之则血凝，血凝则发热，恶食，病日痼矣”。吐血之来，见有只吐一二口而止者；有来势颇急倾碗盈盂而吐者；亦有始吐数口继而大吐者。故治法根据证情，针对病势，当以止血为第一要着。盖血止虽有宿瘀而尚徐可图治；若血出不止，则血竭气越，顷刻可以告危。止血之法，旧传通用之方有花蕊石散、十灰散。愚遇火热上扰阳络受损之吐衄失血诸证，通常采用十灰散（大蓟、小蓟、柏叶、荷叶、茜根、茅根、山栀、丹皮、大黄、棕榈皮各烧灰存性，食远服２０～３０克，童便调下。亦可用大黄醋炒、山栀、丹皮、柏叶、茜根、茅根，煎汤，大剂频服）凉血止血，均有一定的疗效。曾治堂弟李某某，体素弱，因暑月受热而患吐血，视其面赤心烦，畏热口干，舌红脉数，断为血热妄行之证。急用生地６０克、醋炒大黄炭１２克，浓煎、频服，血即顿止，后未复发。盖生地、大黄并用，甘凉复以苦寒，清热止血而不凝瘀，药味单捷而取效速，是古方之配伍精妙处。若花蕊石出硫磺矿中，品质不纯，尚不敢对吐血重证病人，贸然试用。如间遇气虚夹寒而不摄血者，致发吐血，则可采用温中暖寒益气摄血之法。方用归脾汤合《金匮》柏叶汤（余用此方，以干姜炮用，柏叶、艾叶炒黑存性用，另马通一味，则易以童便合服），殊有良效。又遇素有溃疡患者而发吐血者，则用和胃止血法，常以乌贼骨、白芨、茜根、广三七等，炒为末，山药汤调下。此证大量吐血，气虚防脱，则加人参，亦可用米饮调下，每能收到止血的效果。
以上血证若误用行血祛瘀药，不救。
Also treated Li XX, female, 35 years old. In a certain summer month, after contracting a common cold (Gaomao), she developed fever (Fare). After taking exterior-releasing medicines (Jiebiao Yao), the fever subsided, but several purpura spots (Zidian) suddenly appeared on her lower limbs. Coinciding with the impending menstruation, she sought medical advice. The physician considered this a characteristic of blood stasis (Xueyu) and prescribed several doses of blood-activating and stasis-resolving herbs such as Chuanxiong Rhizoma (Chuanxiong), Angelicae Sinensis Radix (Danggui), Persicae Semen (Taoren), and Carthami Flos (Honghua). Consequently, menstrual flow became excessive like a gushing spring (Benglou), accompanied by epistaxis (Nuxue) from the nose and mouth, and an increase in systemic purpura. Urgent consultation was requested: examination revealed a crimson-red tongue body (Shezhi Hongjiang) and a fine-rapid pulse (Maixiang Xishu). The diagnosis was blood deficiency with latent internal heat (Xuexu Er Fu You Nei Re), which agitated the Yang collaterals (Yang Luo), causing blood to extravasate, leading to systemic hemorrhage, termed "Great Epistaxis" (Da Nu). The observed purpura is a clear sign of blood heat (Xue Re), distinct from the local bruising due to trauma described in Volume 228 of *Zhe Die Da*, which should be treated as blood stasis. Since Chuanxiong and Danggui are acrid and warm, they are contraindicated in blood heat syndromes; using blood-activating and stasis-resolving drugs for this condition is counterproductive, exacerbating blood extravasation and creating a critical state. The rescue method at this stage focused on cooling the Ying level, clearing heat, nourishing Yin, and stopping bleeding (Liang Ying Qing Re Yu Yin Zhi Xue). The prescription was Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction) modified with fried Scutellariae Radix (Huangqin), Agrimoniae Herba (Xianhecao), Imperatae Rhizoma (Maogen), Asini Corii Colla (Ejiao), Pappaveris Pollen Carbonized (Puhuang Tan), Sepiae Endoconcha (Wuzei Gu), Hominis Pilus Carbonatus (Xuyutao), Rubi Caulis et Folium Carbonized (Qiancaogen Tan), and Nelumbinis Nodus (Oujie), decocted in large doses. After three major doses, re-examination showed complete resolution of fever, reduction in purpura, and cessation of epistaxis. Rhinoceros Horn (Xi Jiao) was removed from the formula, and the treatment continued with clearing heat, nourishing Yin, cooling blood, and stopping bleeding to ensure recovery.
IV. Discussion on the Syndrome Differentiation and Treatment of Sha Disease (Sha Bing)
The character "Sha" did not exist in ancient times. In later Traditional Chinese Medicine (TCM), it was used as a disease name with approximately three meanings: 1. It refers to what is commonly known as "Jiao Chang Sha" or "Bi Luo Sha," representing the state of Cholera (Huoluan); 2. It refers to "Lan Hou Sha," characterized by rotting throat ulcers and red spots on the skin, i.e., Scarlet Fever (Xinghong Re); 3. It refers to external contraction of Wind-Heat, presenting with red granules and itching similar to Measles (Ma Zhen), commonly called "Sha Zi," which is milder and mostly occurs in children (as stated in *Zhong Hua Da Zi Dian*). However, the Sha Disease discussed in this article is distinct from these three definitions. Also referred to as Fa Sha, Sha Zhang, or Sha Bing, it is a common acute disease most prevalent during the wheat harvest season in the Jianghan Plain region north and south of the Yangtze River in Hubei Province. Song Dynasty physician Zhang Jiming stated: "Sha disease was previously unknown in Jiangnan, but now exists everywhere east and west. Its symptoms are not recorded by physicians. Generally, one feels chills resembling Taiyang Cold Damage (Taiyang Shang Han) and symptoms resembling Malaria (Nue), with headache, high fever throughout the body, and cold extremities" (*Yi Shuo*, Vol. 3, "Differentiating Sha Disease"). This describes the condition. The Qing Dynasty book *Sha Zhang Yu Heng* by Guo Shitao discusses this disease exclusively, but its content is too complex and its treatments imperfect, making it difficult to grasp the essentials and leaving practitioners confused.
Etiology and Pathogenesis of Sha Disease: This disease is mostly caused by unclean diet in summer, excessive consumption of cold drinks, irregular eating habits, or sleeping outdoors exposed to coolness all night. Internal and external pathogens combine, causing a sudden disorder of ascending and descending functions in the Middle Jiao (Stomach and Intestines), leading to occasional dysfunction of Qi mechanism (Qi Ji). Consequently, the Great Qi in the chest cannot rotate, and the circulation of Ying and Wei Qi and Blood in the meridians of the whole body is obstructed. Thus, symptoms appear including dizziness and fainting, numbness of the four limbs, cold hands and feet, cyanosis of the mouth, lips, and nail beds, general discomfort, resembling the typical symptoms of Sha Zhang discomfort. Some may also present with headache, chills, and high fever. More severe cases may exhibit inability to vomit despite the urge, inability to defecate despite the urge, or abdominal pain, presenting as so-called "Dry Cholera" (Gan Huoluan). Note: The character "Sha" (Sand) consists of water and few; when water is scarce, stones appear. Duan Yucai stated, "Crushed stones are called sand." The character "Sha" likely evolved from "Sha" (Sand), hence *Yi Shuo* identifies this as Sha disease, providing evidence. Folk usage of "Sha" for this disease name roughly matches the clinical presentation.
Treatment Methods for Sha Disease: Broadly divided into external and internal treatments. Due to the acute onset, emergency methods are generally adopted, primarily external therapies. External Treatments: (1) Scraping Method (Gua Fa): Most effective externally. Focus on the entire spine and the bends of both elbows and knees. During scraping, hold a Kangxi bronze coin dipped in green oil or peppermint oil between fingers, scraping from top to bottom, gently increasing pressure, aiming for reddish-purple skin after scraping. This method promotes the dissemination of pathogenic factors, unblocks meridians, and facilitates Qi and Blood circulation; repeated application is highly beneficial. (2) Nasal Insufflation for Sneezing (Chui Bi Qu Ti): Use Wolong Dan or Kaiguan San (commercial preparations) insufflated into the nose to induce sneezing. If unavailable, use small amounts of Asari Radix (Xixin) and Gleditsia Sinensis Spina (Zhuya Zaojiao) ground into fine powder for insufflation. This opens blockages and orifices, promotes Qi circulation, and aids positive transformation of the disease. (3) Bleeding Method (Chu Xue Fa): Use a triangular needle or porcelain needle to prick Zhichuan (LU5), Weizhong (BL40), or Shixuan (EX-UE11), the tip of the tongue, and the two major blue veins under the tongue to bleed. Strict disinfection of needles and sites with alcohol-soaked cotton is required before the procedure. This method guides out pathogenic factors and circulates Qi and Blood. Bleeding volume should be minimal. (4) Pinching Method (Qia Fa): Pinch major tendons and muscles in the shoulders, back, and waist with fingers to promote Qi and Blood circulation and meridian patency, aiding symptom relief. Avoid strong stimulation; only apply until the patient feels pain. (5) Induced Vomiting Method (Tan Tu Fa): Suitable for those with Dry Cholera symptoms (urge to vomit/defecate but unable to do so). Guide the pathology appropriately using boiled salt soup or a white goose feather to stimulate the throat for vomiting, facilitating Qi circulation. (6) Other TCM Emergency Methods: Commercial preparations like Zhuge Xingjun San and Taiyi Zijin Dan can be used externally or internally, kept ready by physicians or patients. For internal medication, the treatment principle focuses on dispersing stagnation, opening blockages, and smoothing Qi mechanism. Mr. Li commonly uses Huo Xiang Zheng Qi San combined with Xiang Su San, modified, combined with external therapy, showing certain efficacy. Herbs include Agastaches Rhizome (Huoxiang), Eupatorii Herba (Peilan), Loquat Leaf (Pipaye), Perilla Leaf (Zisu), Cyperi Rhizoma (Xiangfu), Tangerine Peel (Juhong), Lindera Root (Wuyao), Fried Immature Bitter Orange (Chao Zhishi), Areca Seed (Dafupi), Magnolia Bark (Houpo), Processed Pinellia Rhizome (Fa Banxia), Poria (Fuling), and Fried Medicated Leaven (Chao Jianqu). In some cases, after external treatment stabilizes the disease, no further medication is needed for recovery. Contraindications: Strictly avoid misuse of tonifying and Qi-stagnating herbs like Ginseng Radix (Renshen), Astragali Radix (Huangqi), and Atractylodis Macrocephalae Rhizoma (Baizhu), and reckless use of purgatives like Mirabilite (Xiaoshi) and Rheum Palmatum Radix et Rhizoma (Dahuang). Although this disease presents with cyanotic nails, limb numbness, and cold extremities, the pathogenesis belongs to Excess/Closure syndromes (Bi Zheng), distinct from Shock/Collapse syndromes.
*Yi Shuo* states: "Villages often use moxibustion, considering the appearance of 'sand' (pus/blood) as good; however, some die from bursting pus and blood after moxibustion." This must be known. In the past, when Mr. Li practiced in his hometown, he encountered many patients during summer and autumn. Detailed inquiry revealed causes were mostly habitual consumption of cold drinks and exposure to coolness. He advised against drinking unboiled water and, even in hot summers, sleeping outdoors, he instructed covering the abdomen with a thin quilt. Villagers with the "Sha-prone constitution" (those prone to Sha disease annually) followed this advice and have not suffered from the disease for many years, demonstrating the importance of prevention over cure.
Sha Disease: Ming Dynasty physician Jiang Huangnan in *Ming Yi Lei An* considered it equivalent to "Xie Jie" in *Nei Jing*. When Qing Dynasty physician Wei Yuheng revised *Lei An*, his friend wrote to him (unsigned, also found in Hang Shijun's *Daogu Tang Ji*, likely written by Hang as the preface to *Ming Yi Lei An*), directly criticizing this error, which is correct. However, claiming Sha disease is merely a "minor ailment" is not entirely accurate. There are cases of Sha disease endangering life. The book's discussion on "Xie Jie" synthesizes classic principles and annotations, offering refined arguments worth reading.
Excerpted below for reference by researchers of Sha disease history and literature, and helpful for students of *Nei Jing*.
Appendix: Letter to Wei Yuheng on Xie Jie
The characters "Xie Jie" do not appear in other books. "Xie" means slack/lax, "Jie" means tired. Laxity prevents joints from moving vigorously; exhaustion prevents essence and Qi from being controlled; sinews fail to bind bones, and pulses do not follow their proper order. "Xie Xie Jie Jie" is indescribable and is not a specific syndrome among the hundred diseases. *Nei Jing* mentions this five times: *Ping Ren Qi Xiang Lun* says: "Slow and choppy pulse at the cun position is called Xie Jie." Wang Bing notes: "Indescribable, slow and weak." *Yu Ji Zhen Zang Lun* says: "Excessive Winter pulse makes people Xie Jie." This arises from the pulse. *Ci Nue Lun* says: "Shaoyang Malaria makes the body feel Xie Jie, not very cold, not very hot, aversion to people, palpitations, excessive sweating." This arises from Malaria. *Ci Yao Lun* says: "Needling bone without injuring marrow; if marrow is injured, it dissolves and aches, and the body feels Xie Jie and does not recover." *Si Shi Ni Cong Lun* says: "Summer needling of meridians exhausts Qi and Blood, making people Xie Jie." This explores the extreme of needling. All arise from the extremities, similar to the description of lethargy in the classics, with slight variations in wording but subtle meaning. Later commentaries and clarifications add two more: *Feng Lun* says: "Causes loss of taste and inability to eat, named Cold-Heat." Loss of taste was originally written as "Shi Wei" by Quan Yuanqi, and *Jia Yi Jing* by Huangfu Mi writes "Xie Jie, then loss of taste is the gradual onset of Xie Jie." *Zhi Zhen Yao Da Lun* says: "If treating heat without distance from heat, do not violate warmth and coolness." Wang Bing notes: "If sweating is not induced to drain excess Yang, heat floods internally into the four limbs causing Xie Jie, indescribable." Crude practitioners call it Ghost Qi. If the disease persists, bone heat, dried marrow, and dry teeth occur, becoming Bone Heat Disease. This explores the extreme consequences of Xie Jie, treating disease after form has appeared. Jiang Huangnan compiled *Ming Yi Lei An*, citing Ye's *Lu Yan Fang* to classify the folk disease "Fa Sha" as a separate category after Epidemic Plague/Da Tou Tian Xing, which is arbitrary. I have experienced Fa Sha myself; upon onset, there is mental restlessness and lower abdominal pain. *Ling Shu* and *Su Wen* do not mention it; it is merely a minor affliction, unrelated to the meaning of Xie Jie. Jiang Huangnan and his son, despite their fame, failed to recognize *Nei Jing*; quack doctors followed their theory to deceive the world. While harmless in practice, the theory is fundamentally wrong. Your continuation of the cases is complete; deleting this section would be prudent to avoid misunderstanding *Nei Jing*. My humble words may be considered.
V. Discussion on the Syndrome Differentiation and Treatment of Jing Li Kou and Ku Li Kou
Ye Tianshi's *Wen Re Lun* summarizes previous theories through clinical practice regarding the differentiation of Wei, Qi, Ying, and Blood levels in Warm Diseases, distinguishing Feng Wen and Shi Wen, identifying macules and papules, examining the tongue and teeth. It provides significant guidance for the differentiation and treatment of common and frequent Warm Diseases.
Specifically, the "Bai Li Kou" mentioned in the book seems to be first proposed by Ye, stating what others had not said and revealing what others had not discovered. According to *Wen Re Lun*: "Another type of Bai Li Kou appears as small grains like crystal color. This indicates Damp-Heat injuring the Lung; although the pathogen exits, Qi and Fluids are exhausted, requiring sweet medicines to tonify. If not prolonged to injure Qi and Fluids, it is due to Dampness stagnating in the Wei level and incomplete sweating, requiring regulation of Qi level pathogens. Or if white like dead bone, it is ominous, indicating exhaustion of Qi and Fluids." Based on my personal experience treating this disease, I discuss my insights below.
Note: Bai Li Kou appearing like crystal color is called Jing Li Kou; if white like dead bone, it is called Ku Li Kou. Bai Li Kou is mostly seen during the peak of Damp-Heat in summer and autumn, when heavenly heat burns downward and earthly moisture rises upward. Dampness stagnation and heat steaming easily cause infection. Especially in the Jianghan Plain region of Hubei, this disease is most common. Initial symptoms often include mild chills and fever, sweating, chest oppression, white-yellow slippery coating on the tongue, dry mouth without desire to drink, abdominal distension and discomfort, loose but difficult stool, poor appetite, short yellow urine, and a soggy-rapid pulse. Treatment principles should refer to Damp-Heat methods, differentiating by Three Jiao. Medications include: Upper Jiao dispersion with Agastache Leaf (Huoxiang Ye), Eupatorium Leaf (Peilan Ye), Loquat Leaf (Pipaye), Apricot Seed (Xingren), Mint (Bohe), Fresh Lotus Leaf (Xian Heye); Middle Jiao widening with Magnolia Bark (Houpo), Fried Immature Bitter Orange (Chao Zhike), Tangerine Peel (Juhong), Areca Seed (Dafupi), Citron Peel (Xiangyuan Pi); Lower Jiao draining with Liu Yi San, Red Poria (Chi Fuling), Coix Seed (Yiyiren), Tetrapanax Pith (Tong Cao), and Plantago Herb (Cheqiancao). Modifications: Add Scutellariae Radix (Huangqin) and Bamboo Leaf (Zhuye) for intense heat; add Atractylodis Rhizoma (Cangzhu) and Stephaniae Tetrandrae Radix (Fangji) for heavy dampness; add Pinellia Rhizome (Banxia) and Amomi Fructus Rotundus (Baokou Ren) for vomiting; add Fried Medicated Leaven (Chao Jianqu), Fried Barley Sprout (Chao Maiya), and Fried Millet Sprout (Chao Guya) for food stagnation. After 2-3 doses, dampness drains via bland diuresis, and heat dissipates via acrid dispersion, allowing long-stagnated Qi level pathogens to exit from the Wei level to the skin. Thus, crystal-colored Bai Li Kou appears on the neck, chest, ribs, or abdomen. Once the pathogen is thoroughly expelled, fever subsides, spirit refreshes, and the disease usually resolves. In some cases, Damp-Heat lingers, fever persists after Bai Li Kou eruption, requiring frequent use of clearing, dispersing, and promoting emergence medications until Bai Li Kou continues to erupt, fever clears, and the disease heals. As Ye stated, prolonged Damp-Heat injuring Qi and Fluids requires sweet tonification. Following Ye's indication suggests nourishing Stomach Yin. However, clinically, this has not been used. Because for Damp-Heat, treatment should prioritize transformation and drainage, avoiding moistening; prioritizing unblocking, avoiding stagnation. This point must be noted even after pathogens are cleared and the disease recedes. Sometimes, ordinary people develop Jing Li Kou in summer and autumn without fever, representing a mild case of Damp steaming and Heat stagnation, which is insignificant. Wu Jutong's *Wen Bing Tiao Bian* uses Yiyiren Zhuye San (Bamboo Leaf, Coix Seed, Talcum, Amomi Fructus, Forsythia, Poria, Tetrapanax Pith) using acrid-cool bland method to treat "Dampness stagnating in meridians, fever and body pain, excessive sweating and spontaneous diarrhea, white rash on chest and abdomen, internal and external combined pathogens." The so-called white rash corresponds to crystal-colored Bai Li Kou. The statement "Pure acrid moving to the exterior, pure bitter clearing heat, both are contraindicated" is also insightful. However, this formula seems too weak for Damp steaming and Heat stagnation with fever and diarrhea presenting Bai Li Kou, likely insufficient to overcome the disease.
If white like dead bone, Ye judged it as "mostly ominous." Wang Xiecheng said, "Not only cannot be saved, but not even worth saving," which is factual. I recall a summer year, the younger brother of Wu from Suohe XX Pharmacy, aged 20+, suffering from Shi Wen for many days unresolved. Wu invited consultation. Upon arrival, the patient's tongue was purple like pig liver, pulse like a sparrow pecking, hands grasping at empty air, consciousness fluctuating between clear and obscure, occasional delirious speech, and fever had not subsided since onset. Examination revealed dozens of Bai Li Kou white like dead bone on the neck, chest, and ribs. I said: This is a deteriorated syndrome from prolonged Damp-Heat. Pathogens have not emerged, and healthy Qi is severely damaged, hence the pulse and symptoms show this collapse, and Ku Li Kou is already visible. Predecessors spoke of Qi exhaustion; interpreting their meaning, it seems sweet-cool medicines should be used to nourish Qi and Fluids. However, at this dangerous stage, revival is unlikely. Before medication could be administered, the patient died. Nevertheless, regarding Ku Li Kou, I believe there are occasional cases that can be saved. Therefore, comprehensive syndrome differentiation and careful treatment should still be attempted, striving for improvement, rather than universally assuming inevitable death. For example, treating Mrs. Ding, age 40. She had a chronic history of abnormal uterine bleeding (Lou Hong). One autumn, she contracted Warm Fever. After two doses of clearing and resolving medicines, blood suddenly gushed like a collapse. Consultation revealed extreme fatigue, irritability, insomnia, vague speech, and irrelevant answers. Tongue was pale white, pulse deficient and fine. At the time of diagnosis, bleeding had slightly stopped but still leaked. Examination of the epigastrium, chest, and ribs revealed multiple Ku Li Kou. Fortunately, fever subsided, which is great luck amidst misfortune. Targeting the main current symptoms, treatment focused on stopping abnormal uterine bleeding (Benglou) using methods to tonify Heart and Spleen, stop leakage, and secure the lower jiao. A large dose of Guipi Tang (Restore the Spleen Decoction) was used with added Asini Corii Colla (Ejiao), Sepiae Endoconcha (Wuzei Gu), Rubi Caulis et Folium Carbonized (Qiancaogen Tan), Fried White Peony Root (Chao Baishao), and Hominis Pilus Carbonatus (Xuyutao). After three doses, leakage stopped, but spirit remained greatly fatigued. Subsequently, small doses of Guipi Tang modified were used for months until recovery. After healing, all body hair fell out completely, making this the only observed cure for Ku Li Kou.
VI. Brief Discussion on Miao Zhongchun's Three Essential Methods for Treating Hematemesis
Miao Zhongchun's three essential methods for treating hematemesis include: First, "It is better to move blood than to stop bleeding." "When blood does not flow in meridians, it is due to rebellious Qi blocking upwards. Moving blood allows it to follow meridians, and bleeding stops naturally. Stopping it causes blood coagulation; coagulated blood leads to fever, anorexia, and chronic illness." Hematemesis varies: some spit only one or two mouthfuls and stop; some come rapidly filling bowls and cups; some start with a few mouthfuls then become massive. Therefore, treatment based on syndrome and disease trend should prioritize stopping bleeding as the primary measure. Although stopping bleeding leaves residual stasis that can be treated gradually, continuous bleeding leads to blood depletion and Qi escape, becoming critical instantly. Old universal formulas for stopping bleeding include Huarui Shi San (Flower Core Stone Powder) and Shihui San (Ten Ash Powder). For cases of hematemesis and epistaxis due to Fire-Heat disturbing Yang collaterals, I usually adopt Shihui San (Large Thistle Root, Small Thistle Root, Cinnamomi Cortex, Lotus Leaf, Rubi Radix, Imperatae Rhizoma, Gardenia Fruit, Moutan Cortex, Rhubarb, Palm Fiber, each carbonized, taken 20-30g far from meals, mixed with child's urine. Alternatively, Rhubarb stir-fried with vinegar, Gardenia, Moutan, Cinnamon Twig, Rubi, Imperata decocted, taken frequently in large doses) to cool blood and stop bleeding, showing certain efficacy. I once treated my cousin Li XX, who was constitutionally weak, suffering hematemesis due to summer heat. Examination showed red face, irritability, aversion to heat, dry mouth, red tongue, and rapid pulse, diagnosed as reckless bleeding due to blood heat. Urgently using 60g Rehmanniae Radix (Shengdi) and 12g Vinegar-fried Rhubarb Charcoal (Chuda Huang Tan), decocted strongly and taken frequently, bleeding stopped immediately and did not recur. Using Shengdi and Dahuang together, sweet-cool combined with bitter-cold, clears heat and stops bleeding without causing stasis; the simple formula achieves rapid effect, demonstrating the exquisite compatibility of ancient prescriptions. If Huarui Shi comes from sulfur mines and is impure, I dare not rashly try it on severe hematemesis patients. Occasionally encountering Qi deficiency with cold failing to control blood, causing hematemesis, warm middle, dispel cold, tonify Qi, and control blood methods can be used. Formula: Guipi Tang combined with *Jin Gui* Baiye Tang (I use this formula with processed Ginger (Ganjiang), blackened Cinnamon Twig (Baiye) and Mugwort Leaf (Aiyе) carbonized; for Horse Urine (Matong), substitute with child's urine mixed for administration), showing excellent efficacy. For patients with ulcers developing hematemesis, harmonize stomach and stop bleeding methods are used, often grinding Cuttlebone (Wuzhigu), Bletillae Rhizoma (Baiji), Rubi Radix, and Panax Notoginseng Radix et Rhizoma (Sanqi) into powder, mixed with Yam Soup (Shanyao Tang). For massive hematemesis with Qi deficiency preventing collapse, add Ginseng Radix (Renshen), or mix with rice water, often achieving hemostatic effects.
If blood syndromes above are mistakenly treated with blood-moving and stasis-resolving medicines, they are incurable.