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Blood is like water; when water flows beneath the earth and all rivers are orderly, there is no danger of blockage or bursting. Blood circulates through the Ying (Nutrient) channels and Fu Shu (Stream and Spring) points of the body; if it is not injured externally by the Four Qi (Wind, Cold, Summer-heat, Dampness) nor depressed internally by the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), it flows naturally smoothly. If there is even a slight deviation in its regulation, it will inevitably lead to stagnation and obstruction. Consequently, blood cannot follow the meridians to nourish the hundred vessels; it may become stagnant or scattered, flow downward leading to hemorrhage, or reverse upward leading to overflow. Thus, various syndromes such as hematemesis (vomiting blood), epistaxis (nosebleed), hematochezia (blood in stool), hematuria (blood in urine), hematohidrosis (sweating blood), and hemoptysis (coughing up blood) arise. Among the ten types of blood loss, none is more severe than these. Only by distinguishing them according to their specific manifestations can treatment be applied.

When a patient is injured by Wind, Cold, Summer-heat, or Dampness, the pathogenic factors spread through the meridians, causing Yin and Yang to contend with each other. Therefore, blood coagulates and becomes stagnant when exposed to Cold, and overflows when exposed to Heat. Depending on the affected Zang-Fu organs and meridians, it surges and exits through the clear pathways. Epistaxis involving one sheng or one dou of blood is attributed to external causes. There are specific formulas for treating each condition.

For cases where Wind injury persists despite sweating or purging therapies, with pathogenic factors stagnating in the meridians and surging out with Qi, causing clear blood to flow from the nose; or when the clear pathway is blocked, allowing blood to enter the stomach tube and be vomited as clear blood, which turns dark and瘀黑 (stagnant black) upon exposure to Cold:
Guixin (Cinnamon Heart), Baishaoyao (White Peony Root), Gualougen (Trichosanthes Root), Gancao (Licorice Root, honey-fried), Chuanxiong (Szechwan Lovage Rhizome) — equal parts.
Grind into coarse powder. Take four qian per dose, with one and a half sheng of water, three slices of ginger, and one jujube. Decoct until reduced to seven-tenths, strain, and take warm. Add Shigao (Gypsum) if headache is present.

For cases of Taiyang Cold Damage (Shanghan) with fever, where exterior resolution fails, causing blood to stagnate with Qi, known in the world as "Red Sweat" (Hong Han):
Mahuang (Ephedra Herb, nodes removed, boiled in water, two liang and half), Shengma (Cimicifugae Rhizoma, one liang and one fen), Huangqin (Scutellariae Radix), Shaoyao (Peony Root), Gancao (Licorice Root, raw), Shigao (Gypsum, crushed), Fuling (Poria) — each one liang.
Grind into coarse powder. Take four qian per dose, with one and a half sheng of water and three slices of ginger. Decoct until reduced to seven-tenths, strain, and take hot. A slight sweat indicates resolution.

For cases of latent Summer-heat and excessive heat intake, where Summer-heat Qi enters the meridians, causing stagnation and overflow leading to epistaxis; or due to deficiency of Stomach Qi, blood渗 (seeps) into the Stomach, remains stagnant, and results in vomiting approximately one to two sheng of blood. (See this formula under the Summer-heat Injury section. For treating epistaxis, administer with decoction of Maohua [Imperata Rhizoma flower head], which has proven effective repeatedly.)