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There are four types of bleeding disorders: bleeding from the teeth is called Chi Nu (Tooth Bleeding); bleeding from the nose is called Bi Nu (Nosebleed); vomiting blood from the throat is called Ou Xue (Vomiting Blood); coughing or spitting blood from the larynx is called Ke Xue (Coughing Blood), Luo Xue (Spitting Blood), Tu Xue (Hematemesis), or Tuo Xue (Saliva with Blood). Although all involve blood loss, their severity varies significantly.

The mildest is Tooth Bleeding. The Foot-Yangming Stomach Meridian passes through the nose into the upper teeth, and the Hand-Yangming Large Intestine Meridian ascends the neck, passes through the cheek, and enters the lower teeth. If heat pathogen is excessive in these two meridians, blood circulating along them may overflow from the teeth. Since the blood pathway is open, even without heat pathogen, it may occur frequently; this causes little harm to the body and requires no medicinal treatment.

Slightly more severe is Nosebleed. All meridians ascending to the head connect downward to the nose. The Shaoyang Gallbladder Meridian ascends to the temple; the Taiyang Bladder Meridian ascends to the forehead and intersects at the vertex; the Yangming Stomach Meridian ascends to the frontal skull. Blood circulates within the meridians following Qi, moving freely without staying fixed. When forced by heat pathogen in these three meridians, blood leaks from the nose. Tongzi Bian (Child's Urine) can guide heat downward, and Bai Mao Gen (Rhizoma Imperatae) clears the stomach and descends fire, stopping the bleeding immediately. However, if bleeding is excessive and unceasing, the cause is not attributed to blood heat but to Qi deficiency. Solid blood cannot be replenished instantly, so vital Qi must be restored quickly. Urgently use Renshen (Radix Ginseng) to tonify Qi and control blood (Empirical Formula: Huangqi 30g, Danggui 9g, guided by Shengjiang and Dazao). Tonifying Qi controls blood, generates blood, and even if the patient is critically weak, recovery is possible.

In cases of Nosebleed due to Shanghan (Cold Damage), known as "Red Sweat," the heat resolves with the blood; hemostasis and diaphoresis are unnecessary. In plague-induced Nosebleed, known as "External Ulceration," toxins decrease with blood loss; hemostasis and purgation are unnecessary. With clear meridians and symptoms, appropriate herbs can be applied directly.

Slightly more severe is Vomiting Blood, located in the Wei Fu (Stomach Organ). Accumulated over time, stagnation leads to upward vomiting, filling basins and bowls, forming clumps. It may occur monthly, bi-monthly, or annually. Before vomiting, there is depression and discomfort; after vomiting, one feels refreshed. As long as the blood pathway remains patent, some may vomit blood until old age without injury. The danger lies in blood blocking Xi Men (the glottis/respiratory opening) (Emergency Method: stimulate the nasal mucosa with a paper twist to induce sneezing, thereby opening the passage), leading to sudden death. Medical texts rarely explain this mechanism. The Stomach is the sea of the five Zang and six Fu organs; blood easily accumulates here. Dietary retention forms stasis, creating nests that sustain themselves like ant hills or fish pools. Tonification nourishes the stasis; cooling merely blocks the pathway. Therefore, only Sanqi (Radix Notoginseng) and Yujin (Rhizoma Curcumae) can break the fortified city; Huai Nixi (Radix Achyranthis Bidentatae) and Dahuang (Radix et Rhizoma Rhei) can open the descending pathway (Proposed Formula: Sanqi, Yujin, Niuxi, Dahuang, Dangguiwei, Taoren, Zhishi, refined honey pills). Sweeping away and purging the stasis offers hope for cure. Mountain dwellers often use herbal remedies for blood disorders, achieving many cures, proving that these herbs possess blood-breaking properties.

The most severe are Hematemesis, Coughing Blood, Spitting Blood, and Saliva with Blood. Etiologies vary, but the source lies in the Five Zang organs. Zang organs store blood to nourish Shen (Spirit), Hun (Ethereal Soul), Po (Corporeal Soul), Yi (Intellect), Jing (Essence), and Zhi (Will). If the Heart does not govern blood, Shen dissipates; if the Spleen does not control blood, Yi becomes confused; if the Liver and Lung do not return blood to its proper position, Hun and Po wander; if the Kidney does not store blood, Jing and Zhi are destroyed. A single drop of blood relates to life and death; prognosis depends entirely on the pulse.

If the pulse is weak and deficient, indicating fire has not yet flared, Guipi Tang (Spleen-Restoring Decoction: Renshen, Baizhu, Fuling, Suanzaoren, Longyanrou, Huangqi, Danggui, Yuanzhi, Muxiang, Zhigancao, guided by Shengjiang and Dazao) and Yangying Tang (Nourishing Camp Decoction: Renshen, Baizhu, Huangqi, Zhigancao, Chenpi, Rougui, Danggui, Shudihuang, Wuweizi, Fuling, Yuanzhi, Jiubaishao, guided by Shengjiang and Dazao) are effective. If the pulse is surging and rapid, internal fire is blazing. The fiercer the fire, the greater the blood loss; the greater the blood loss, the more deficient the Yin. Thus, extreme Yang pathogenic factors inevitably damage Yin. At this stage, cold-natured herbs may destroy the vital energy of the Zang organs, while warm-tonic herbs may damage the true Yin of the Kidneys. One must use cold-natured herbs to nourish Yin while simultaneously supporting Yang (refer to Tuberculosis discussion), allowing blood to return to its proper position.

Another scenario involves internal cold invading the Zang organs, causing blood to act recklessly outside its normal position. The pulse is weak and slow. Without Fuzi (Lateral Root of Aconite) and Ganjiang (Dried Ginger), cold cannot be dispelled and meridians warmed (Empirical Formula: Fupian, Ganjiang, Huangqi, Baizhu, Danggui, Zhigancao, Jianyuan, Nanzao guided). This occurs in only one or two out of a hundred cases. If external cold invades the Zang organs, disturbing blood causing it to rebel upward, the pulse is floating and tight. Only Mahuang Renshen Shaoyao Tang (Ephedra, Ginseng, and Peony Decoction: Guizhi 1.5g, Mahuang, Huangqi, Gancao, Baishao 3g each, Renshen, Maidong 9g each, Wuweizi 5 berries, Danggui 1.5g) can attack the cold and stabilize the blood. This is a common occurrence in blood disorders and is not surprising. Therefore, blood disorders related to the Five Zang organs require pulse diagnosis for accurate decision-making.

In summary, consider the military analogy: Tooth Bleeding and Nosebleed are patrol soldiers; Vomiting Blood is guard soldiers; Coughing, Vomiting, Spitting, and Saliva-with-blood are camp-defending soldiers. Patrol soldiers may be lost, guard soldiers may be lost, but camp-defending soldiers must never be lost. After forty years of research and observing thousands of lives, I dare to detail the pathways of blood.

(Sima Liu Qinzao suddenly suffered from blood loss and asthma with a weak and slow pulse. Using heavy doses of Fuzi, Ganjiang, and Huangqi, he recovered immediately. Thereafter, he devoted himself to medicine, lecturing on the Ling Shu, Su Wen, and Nan Jing.)