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All Yang channels are affected by disease, harboring pathogenic heat. When the pathogen is in the exterior, sweating should be induced, but if sweat does not emerge... (The *Zhu Bing Yuan Hou Lun* states: Hematemesis is caused by all Yang channels receiving pathogenic heat. Initially in the exterior, sweating should be induced, but if it fails to emerge, the heat-toxin penetrates deeply, knotting within the five Zang organs. With internal blood stasis accumulating, hematemesis occurs.) If the heat-toxin penetrates deeply and knots in the middle, once the blood stasis has settled, hematemesis must follow. For mild cases, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is used; for severe cases, Didang Tang (Ephedra and Persimmon Seed Decoction) is required to eradicate the condition. (*Xiaopin Fang*'s Xijiao Dihuang Tang treats Shanghan and warm diseases where sweating should have been induced but was not, leading to internal blood stasis, as well as epistaxis and hematemesis. Didang Tang treats internal blood stasis.) If a drastic purgative is misused, causing the Cun (inch) pulse to become deep and slow, Shengma Tang (Cimicifuga Decoction) cannot be omitted when treating hematemesis. (The syndrome description for Yangdu Shengma Tang states: Yang Du results from two medications; after vomiting or purging, Yang Du forms. Symptoms may include hematemesis with dysentery, a floating-large-rapid pulse, red face with patterns like brocade, and spitting of pus and blood; this decoction treats such cases.)

Taiyang excess Yang necessitates epistaxis for resolution. Once resolved by epistaxis, what benefit remains? (Chao Shi states: A floating-tight pulse with fever and no spontaneous sweating leads to self-resolving epistaxis. Generally, Taiyang syndromes may resolve spontaneously through epistaxis.) Floating-tight pulse with no sweating indicates Mahuang Tang (Ephedra Decoction); floating pulse with spontaneous sweating indicates Guizhi Tang (Cinnamon Twig Decoction). If these fail to cure the disease and the pulse remains unchanged, they may be administered again. (Zhang Zhongjing states: In Shanghan with a floating-tight pulse, if sweating is not induced and epistaxis ensues, Mahuang Tang is indicated. Thus, for spontaneous sweating with a floating pulse, Guizhi Tang is appropriate. Mahuang Tang and Guizhi Tang distinguish between exterior excess and deficiency. If ineffective, re-administration is permissible, per the *Huo Ren Shu*. However, one must examine carefully. Further reading of Zhang's texts notes: In Yangming disease, dry mouth with desire to drink but inability to swallow indicates impending epistaxis. Patients prone to epistaxis should not undergo exterior-releasing treatments. Sweating may cause forehead depression, fixed gaze, insomnia, and... Also, patients with blood loss should not undergo exterior-releasing treatments; sweating may cause chills and tremors.) After epistaxis, if the pulse is faint and blood is deficient, do not administer [exterior-releasing herbs] lest the illness worsen. Consider Xijiao Dihuang Tang; if bleeding persists, Maohua Tang (Sedge Flower Decoction) should be prepared promptly. (If the pulse is faint and blood is deficient, neither Mahuang nor Guizhi should be used. *Duanju Fang* recommends Xijiao Dihuang Tang; *Huo Ren Shu* states Maohua Tang is also applicable.) Yin syndromes originally lack this manifestation. Shaoyin syndrome forcibly manifesting redness triggers danger. Lower Jue and Upper Exhaustion are incurable; blood flows from the mouth, nose, ears, or eyes. (Zhang Zhongjing states: In Shaoyin disease, desiring no sweating, but forcing sweating induces epistaxis. The exit route is unknown; it may flow from the mouth, nose, ears, or eyes. This is termed Lower Jue and Upper Exhaustion, making it difficult to treat.)