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The *Classic* (Huangdi Neijing) states: When Yangming channel qi rebels, there is panting and coughing, body heat, a tendency to be startled, nosebleeds, and hematemesis; it also says: Great anger causes the form and qi to sever connection, causing blood to stagnate in the upper part; it also says: If spleen transfers heat to the liver, it results in startle and nosebleed; if the bladder's "bao" (uterus/bladder organ) transfers heat to the bladder, it results in strangury and hematuria; it also says: In Jieyin disease, bloody stool occurs with one sheng of blood loss, two sheng upon recurrence, and three sheng upon a third recurrence. Blood is generated by the Spleen, commanded by the Heart, stored and regulated by the Liver, distributed by the Lungs, and excreted by the Kidneys, irrigating the whole body. The eyes obtain it to see, the ears to hear, the hands to grasp, the palms to hold, the feet to walk, the Zang organs to produce fluids, and the Fu organs to generate Qi. Through its entering, exiting, ascending, and descending, it moistens, nourishes, and unblocks, all relying on this. Daily nourishment from food and drink allows Yang to generate and Yin to grow; juices are transformed into red blood, injected into the vessels. When full, it is solid; when scant, it is astringent. When vigorous, all channels rely on it for nourishment; when exhausted, all pulses become empty due to this. Abundant blood means robust form; weak blood means declining form. Calm spirit generates Yin; physical labor overexerts Yang. Thus, blood is hard to create but easy to deplete. Once imbalanced, pathology arises instantly. Fire carrying it upward causes it to rise; dampness carrying it downward causes it to descend, resulting in various diseases. Reckless movement upward causes vomiting and nosebleeds; depletion and drying in the middle leads to deficiency consumption; withering externally leads to emaciation; reversal downward leads to red stool; heat transferring to the bladder causes hematuria; permeating the intestines becomes intestinal wind; Yin deficiency with Yang pulsation causes metrorrhagia; damp-heat steaming and stasis causes dysentery; extreme heat rotting causes visceral bleeding; extreme fire resembles water, with large amounts of blood appearing purple-black; heat surpassing Yin causes sores and ulcers; dampness stagnating in blood causes urticaria; coagulation and astringency in the skin causes cold bi-syndrome; accumulation in the upper part causes madness; accumulation in the lower part causes mania; falls and injuries cause internal blood stasis. Blood traveling through clear pathways exits the nose; blood traveling through turbid pathways exits the mouth. Hemoptysis and nosebleeds originate from the Lungs; hematemesis originates from the Liver; hematemesis originates from the Stomach; bloody sputum originates from the Spleen; spitting blood originates from the Heart; spittle blood originates from the Kidneys. Ear bleeding is called "Er Xue", nosebleeding is called "Nu", skin bleeding is called "Xue Han", simultaneous mouth and nose bleeding is called "Nao Nu", and bleeding from all nine orifices is called "Da Nu". Clear bloody stool belongs to Ying blood deficiency with heat; turbid belongs to heat and dampness; bright red belongs to fire; black indicates extreme fire; blood mixed with excrement belongs to accumulation or collateral injury. Hematuria due to excessive sexual activity, Yin deficiency with fire stirring, reckless Ying blood movement, dark blood color, withered white complexion, and deep-slow Chi pulse indicates deficiency-cold of the lower Yuan, as stated: "When Yang is deficient, Yin must escape." Vomiting purple clotted blood: The *Yuan Bing Shi* says: This is not cold coagulation, but severe heat scorching it into thick turbidity; severe heat is controlled by water transformation, hence red mixes with black to appear purple. Sweating blood occurs due to great joy injuring the Heart; joy disperses Qi, and blood follows Qi. Lower bleeding: seeing blood before stool is "Jin Xue" (near blood), coming from the Large Intestine; seeing stool before blood is "Yuan Xue" (far blood), coming from the Lungs and Stomach. The intestines and stomach naturally have no blood; due to Qi deficiency and thin intestinal walls, blood seeps in and exits downward. Li Dongyuan said: Excluding nosebleeds in Shanghan cases, miscellaneous diseases with bleeding are mostly attributed to heat. Upward flow is rebellious and difficult to treat; downward flow is smooth and easier to treat. Thus, if upward bleeding (spitting, vomiting, or throwing blood) suddenly changes to downward bloody diarrhea, it is an auspicious sign. Zhu Danxi said: Bleeding from mouth and nose is all due to Yang excess and Yin deficiency, rising without descending, with blood following Qi up and escaping through small orifices. The method should be tonifying Yin and suppressing Yang; when Qi descends, blood returns to its vessels. In cases of original Yang deficiency compounded by cold-cold injury, showing肃杀 (killing/drying) Qi signs, with colors and pulses sinking rather than floating, Chi pulse smaller than Cun pulse, Right pulse weaker than Left, withered complexion and dark blood, use Shengmai San plus Rougui (Cinnamon Twig) 1 qian, Shufuzi (Prepared Aconite Root) 1 qian, Gancao (Licorice Root) 0.5 qian; follow with Lizhong Ba Wei Wan, taken alternately. Panting, coughing, and bloody sputum will subside. Thus, the *Sanyin Fang* states: Lizhong Tang can stop Stomach-injury hematemesis because it best regulates the Middle Jiao, distinguishes Yin and Yang, and stabilizes Qi and Blood. For patients truly suffering from cold invasion and cold food intake, where pathogen enters the blood level, blood coagulates due to cold, fails to return to vessels, and moves recklessly, the blood must be dark, color withered and pale, pulse minute and slow, body cool. Using cooling agents instead of Ginger and Cinnamon would be disastrous.

Medicators must recognize the origin of blood and not treat blindly, causing chaos. Treating blood disorders requires knowing which channel the blood comes from; one cannot simply say hematemesis and nosebleeds are mostly fire carrying blood up, causing wrong channel movement and escape through upper orifices, leading to overuse of cold-cooling herbs. Fire is formless Qi, incomparable to water, how can it "carry"? Blood follows Qi; when Qi is smooth, blood follows channels; when Qi rebels, blood is chaotic. Excess Qi is fire. It is actually Qi rebellion causing reckless blood movement, compounded by fire transformation, making it severe. The *Classic* says: Anger causes Qi rebellion, severely causing vomiting blood; sudden heat illness internal rebellion, Liver and Lung fighting, blood overflowing from nose and mouth is like this. Also, Li Dongyuan said: Blood moving recklessly out of nose and mouth is all due to Qi rebellion. Moreover, blood coagulates with cold, flows with heat, and stops when black. From this, treating blood without regulating Qi, using only cold-cooling herbs, means blood will not return to channels, will be stagnant due to cold, and although temporarily stopped, will recur. Since the Spleen commands all blood, cold-cooling damages the Spleen; Spleen deficiency cannot constrain blood, and its pathological changes are countless! However, regulating Qi is best done by guiding fire; when fire returns, Qi becomes smooth.

Hematemesis is Ying Qi overflowing into the turbid pathway, accumulating between the diaphragm; when full, blood vomits, named "Nei Nu" (Internal Nosebleed). Ancient sages considered it heat, but cold causes exist. Why? Cold pathogen is Yin; Ying blood is Yin. Wind injures Wei, Cold injures Ying, each following its kind. If the body suffers pathogens and mouth eats cold things, pathogen enters blood level, depressing internal heat with no outlet, blood boils, exiting from mouth above or stool below. Such cases exist in pathology mechanisms, how can they be nonexistent? Only the black blood color resembles heat-excessive blood undergoing water transformation. Here, one must seek differentiation in pulse and symptoms: minute-slow pulse and cool body indicate cold; surging-rapid pulse and restless heat indicate heat. Cold is warmed, heat is cleared; treatments differ greatly. If hematemesis with thirst occurs, it is named "Xue Ke" (Blood Thirst), suitable for Siwu Tang or Shiquan Dabu Tang.

For acute internal injury hematemesis not stopping, or excessive labor causing reckless blood flow like a gushing spring, flowing from mouth and nose, requiring urgent rescue, use Ren Shen (Ginseng Root) 1 liang or 2 liang, powdered, mixed with Feiluo Mian (Fine Wheat Flour) 2 qian, adjusted with fresh well water to a thin paste, taken anytime; or use Dushen Tang alone. Ancient formulas use only Qi-tonifying herbs, no blood herbs. Why? Yang commands Yin, blood follows Qi. Formidable blood cannot be quickly generated; formless Qi must be urgently secured, allowing formless to generate formidable. If True Yin is lost, Deficient Yang floats up, causing massive hematemesis, requiring Bawei Dihuang Tang to secure True Yin and guide fire back to source; Ren Shen is inappropriate here. Once fire is guided back, Ren Shen is permitted. Yin and Yang must be distinguished, timing clarified, wisdom applied. Although Ren Shen is said to tonify Yang, it is a Yin herb within Yang. Used with Baizhu (Atractylodes Rhizome) and Huangqi (Astragalus Root), it vigorously tonifies Postnatal Yuan Qi Yang; used with Fuzi (Prepared Aconite Root) and Lurong (Deer Antler Glue), it greatly tonifies Prenatal Yuan Qi Yang; used with Danggui (Angelica Sinensis Root) and Dihuang (Rehmannia Root), it tonifies Yin within Yang, leading the group of Yin herbs to the Yin portion within Yang. Slight differences in assistance lead to different functions.

After blood loss, high fever always occurs, named "Xue Xu Fa Re" (Deficiency Blood Fever). Ancient formula Danggui Buxue Tang uses Huangqi (Astragalus Root) 1 liang and Danggui (Angelica Sinensis Root) 2 qian. Named "Tonifying Blood," but Huangqi is sovereign; Yang prosperity generates Yin blood. Danji used Renshen, Huangqi, Danggui, Chuanxiong, and Heijiang (Charred Ginger) for postpartum fever. Asked why pungent-hot Ganjiang (Dried Ginger) is used? Ginger is pungent, guiding blood herbs into Qi level to generate new blood; charred ginger stops movement. Without understanding this, seeing high fever and surging-large six pulses, mistakenly using dispersants or Baihu Tang (White Tiger Decoction) due to resemblance, leads to immediate danger. Caution!

Cao Shi said: For hematemesis, decoct Ganjiang (Dried Ginger) and Gancao (Licorice Root) as soup to take, or Sili Lizhong Tang is also fine; such cases heal invariably. Taking Shengdihuang (Rehmannia Root), Ouji (Lotus Rhizome Juice), Zhuru (Bamboo Shavings) drives away life. *Ren Zhi Zhi Zhi* says: Blood flows freely with heat, so hemostasis often uses cooling drugs. But in Qi deficiency with cold, Yin and Yang do not guard each other, Ying Qi is deficient and scattered, blood moves wrongly, as stated: "When Yang is deficient, Yin escapes." External signs of deficiency-cold exist; method should warm the middle. Warming middle makes blood return to channels; Lizhong Tang plus Nanmuxiang (Aquilaria Wood) or Ganjiang Gancao Tang is usable. Effect is obvious. Food damaging Stomach or Stomach deficiency failing to transport transforms causes Qi rebelling upward, also causing hematemesis/nosebleed. Muxiang Lizhong Tang, Ganjiang Gancao Tang are most suitable. Various bleeding syndromes often conclude with Stomach medicines. Do not administer bitter-cold agents. Thus: For real-fire blood, regulating Qi is first; for deficiency-fire blood, nurturing righteousness is first. Strong Qi naturally controls blood.

*Chu Shi Yi Shu* says: Throat has orifices, coughing blood kills; intestines have orifices, bloody stool kills. Bloody stool is treatable; coughing blood is hard to cure. Throat tolerates no object, slightest thing causes cough. Once blood permeates, more permeation causes more cough, more cough causes more permeation. Drinking urine saves one in a hundred; taking cold-cooling drugs kills one in a hundred (accurate statement). Blood is Yin category, but what moves it is Yang harmony. Playing with "Yang Harmony," Chu deeply understood Yin-Yang subtleties. Shizhen said: Urine is warm, not cold. Drinking it enters Stomach, follows Spleen Qi, goes up to Lungs, down through water passages to Bladder, its old path, thus treating Lung disease, guiding fire downward. Its salty taste enters blood, thus treating blood disease. Must drink hot; true Qi remains, action is fast. Cold leaves only salty-cold nature. If refined into Qiushi (Autumn Stone), true Yuan Qi is gradually lost, far inferior to child urine.

Haizang said: Residual fire accumulated in chest, long-standing Taiyin in abdomen, upper-lower diaphragm severed, meridians blocked, Yin-Yang不通 (unconnected). Use bitter-hot to settle middle, pungent-hot to move exterior, sweet-warm to ascend, pungent-moist to descend. Transform solemnity into spring warmth, change biting cold into harmonious Qi, cure via sweating. However, residual toxins remain, whole-body Yang harmony not yet peaceful, slight chest restlessness craving cool drinks. Due to eating cold food/taking cooling drugs, Yang dissipates again, residual Yin acts again. Pulse retreats small, wiry-thin-slow,激 (provoked) into nosebleed/hematemesis occurs, Lung/Heart receiving pathogen. Downward into bloody stool/hematuria occurs, Liver/Kidney receiving pathogen. Sanjiao bleeding, purple-dull color, caused by layered cold-damp, transforming poison, coagulating, water-grain pathways infiltrated. Seeing blood syndrome without detailing origin/ending, immediately using cooling suppression creates variation.

Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) are forbidden. How to treat? If same as previous Lizhong warming-middle method, why distinguish True Yin/True Yang? Not knowing that warming middle regulates Middle Jiao, not Lower Jiao. This concerns Prenatal True Qi in Lower Jiao Kidneys, unrelated to Postnatal formed bodies of Lung/Heart/Spleen/Stomach. Ganjiang, Gancao, Danggui etc. do not enter Kidney meridian. Only Zhang Zhongjing's Bawei Shenqi Wan is appropriate. Kidney contains Water and Fire. Dihuang strengthens Lord of Water; Guifu benefits Source of Fire. Way of Water-Fire mutual satisfaction. Yin deficiency fire stirring is actually Kidney cold; Dragon Palace has no abode, forced to wander upward, so blood follows fire recklessly. Using Guifu (pure Yang fire) added to Liuwei (pure Yin water) warms Kidney, like one Yang returning in winter water. Dragon-Lei fire naturally returns to original home. No cooling needed, fire descends itself; no hemostasis needed, blood calms itself. If Yin water dry and fire flares, remove Guifu, use pure Liuwei to supplement water matching fire, blood calms. No need to remove fire. Overall, protecting fire is main. This is Zhang Zhongjing's mystery for 2000 years, impossible for later generations to edit.

Kidney meridian hematemesis is all lower-cold upper-heat, Yin excess below forcing Yang above, false syndrome. Worldly people don't recognize, misled often. Should treat with false-cold, "false against false." Two types: One is Shaoyin Shanghan, cold pathogen from lower Kidney meridian, lower abdominal pain (or not), vomiting (or not), red face, thirsty but unable to drink, chest irritability. View as Shaoyin external Shanghan, use Zhang Zhongjing's Baitong Tang method, one dose cures. Another is True Yin lost, Mingmen fire decline, fire not returning to source, water excess forcing floating fire upward. Upper Jiao cough/wheeze, aversion to heat/red face, vomiting phlegm-blood. This is false Yang syndrome, use Bawei Dihuang to guide fire back to source. Both formulas are hot drugs. If upper Jiao烦热 (restless heat) is strong, hot drug causes immediate vomiting. Must mix with water to cool, deceive with false cold. After swallowing, cold nature removed, hot nature starts. Sun shines, Dragon-Lei fire rests, vomiting stops. If prescription lacks method, how to pass rejecting cold? Mistaking for real heat and taking cold-cooling drugs leads to instant death. Caution!

Blood coming, though forced by fire, this fire should be guided to return to source, then blood returns to channel. Avoid original drugs, which provoke floating fire rebelling upward, damaging Stomach Qi, making Spleen unable to command blood further. Nourish Liver, make Liver Qi calm, blood has return. Avoid attacking Liver. *Classic* says: Five Zang store Essence-Qi and do not drain. Liver is General, commands storing blood. Hematemesis is Liver losing duty. Attacking it further makes it powerless to control blood storage, blood stops not. Better to move blood than stop blood. Hematemesis is Qi rebelling upward blocking, blood not moving in channels. Moving blood makes it follow channels, stopping itself. Forcibly stopping causes blood stasis, chest-hypochondriac fullness, fever/aversion to food, becoming chronic disease. Blood generated by Spleen, Spleen commands blood. If not regulating Spleen/Stomach as main, using Siwu (pure Yin damaging Stomach) increases disease. Thus *Yi Guan* says: Taking cold-cooling drugs, one in a hundred dies; taking urine, one in a hundred lives. However, long-term use damages Stomach Qi, emphasizing cold-cooling是不可用 (unusable). Blood loss syndrome, critical/frightening, medical effect rare. Sudden onset dies instantly; temporary stop eventually dies. Ask if fixed method exists for perfect benefit? Explain fully. Blood syndromes first divide Yin/Yang. Yin deficiency/Yang deficiency. Yang deficiency tonifies Yang, Yin deficiency tonifies Yin. Direct treatment, known to all. Also True Yin/True Yang. Yang rooted in Yin, Yin rooted in Yang. True Yang deficiency, draw Yang from Yin; True Yin deficiency, draw Yin from Yang. Also False Yin/False Yang, seemingly correct but wrong, misleading many. "True/False" rarely discussed, unheard of. In miscellaneous diseases must know, in blood syndromes especially so. After dividing Yin/Yang, must divide Three Causes. Wind/Cold/Summerheat/Dampness/Dryness/Fire, external cause. Overeating raw/cold, liking roasted/fried, drunken/full excess, external turning internal. Joy/Anger/Worry/Sorrow/Fear, mental labor/lust, internal cause. Falls/dislocations, heavy injury/stasis, neither internal nor external cause. After dividing Three Causes, must prioritize own body Yin/Yang. Or Yin deficiency with external/internal causes, or Yang deficiency with external/internal causes. Yin/Yang deficiency is righteous Qi deficiency in self. Three Causes are pathogenic Qi excess outside. *Classic* says: Where pathogen gathers, Qi must be deficient. Not treating deficiency, how ask about others? Some say: Hematemesis/nosebleed is fire flaming upward from below. Summerheat/dryness/fire should exist, how have Wind/Cold? Not knowing Six Evils all injure humans. Summerheat 10-20%, Fire/Dryness half, Wind/Cold half. After Fire/Dryness, ultimately returns to deficiency-cold. *Classic* says: Year Fire excess, heat summer spreads. Lung Metal punished, people suffer blood overflow/leakage. Fire Qi causes blood loss. Also: Taiyin ruling Heaven, Cold excess wins, blood changes inside, people suffer vomiting blood, leakage, nosebleed, sadness. Cold Qi causes blood loss. Also: Taiyin ruling Earth, Damp excess wins, people suffer blood sight. Damp Qi causes blood loss. Also: Shaoyin ruling Heaven politics, Water/Fire/Cold/Heat hold at Qi intersection. Heat illness above, cold illness below. Cold/Heat invading, fighting in middle. People suffer blood overflow/leakage. Cold/Heat invading causes blood loss. Also: Taiyin ruling Heaven politics, First Qi Wind-Damp combining, people suffer blood overflow. Wind-Damp combining causes blood loss. Also: Year Metal excess, Dryness spreads, people suffer tossing/coughing reversals, severe coughing blood overflow. Dryness Qi causes blood loss. Six Qi all cause blood overflow, why only Fire? Fire has Yin/Fire difference. Sun/Moon fire vs Lamp/Candle fire different. Furnace fire vs Dragon-Lei fire different. Also Five Emotions extreme fire. Startle moving blood, fire starts in Heart; Anger moving blood, fire starts in Liver; Worry moving blood, fire starts in Lung; Thinking moving blood, fire starts in Spleen; Labor moving blood, fire starts in Kidney. Understanding "Fire" word, understanding blood principles is more than half.

Hejian Mr. specifically established theory on Five Movements/Six Qi Summerheat-Fire, thus using only cold-cooling to treat fire, later generations followed. Not knowing Hejian's theory only contrasts with Zhongjing's *Shanghan Lun*, each revealing unfinished points. Not general discussion of various fires. Since Dongyuan Mr. appeared, discussing Spleen/Stomach fire must be warmed/nourished, then cold-cooling forbidden. Since Danxi Mr. appeared, establishing Yin deficiency fire stirring theory, also revealing predecessors' undeveloped points. Pity Dabu Yin Wan/Buyin Wan, both using Huangbai/Zhimu as sovereign, cold-cooling theory prevailed again. Yangkui Mr. wrote Yin-Yang Five Elements theory, clarifying fire cannot be extinguished by water, drugs cannot attack with cold. Benefit vast! Among Six Evils all causing blood disease, Cold Qi causing disease is majority. Why? Cold injures Ying, Wind injures Wei, natural law.