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The principle lies in the fact that the Foot-Taiyang Bladder Meridian belongs to Cold Water, and the Foot-Shaoyin Kidney Meridian belongs to Kidney Water; both are prone to contracting Cold pathogens. Once contracted, the pathogen enters through the skin and hair first. Since the Lung governs the skin and hair, Cold Water leads to Cold Metal (Lung), causing the Lung Meridian to be affected first. Blood also belongs to the Water element; therefore, once the water and blood within the meridians encounter Cold Qi, they become stagnant and cease to flow. This manifests as coughing with phlegm expulsion. Inquiry will reveal aversion to cold, and palpation will reveal a tight pulse. Observation of the expelled blood will show purple or black spots, all of which are signs of Cold pathogenic invasion. If physicians fail to examine carefully and instead assume it is Yin deficiency with Fire hyperactivity, generally using herbs to nourish Yin and descend Fire, the condition will deepen daily, hastening death. Zhao used Ma Huang Gui Zhi Tang (Ma Huang Gui Zhi Tang, Ephedra and Cinnamon Twig Decoction) once, resulting in slight sweating and recovery. This is because sweat and blood share the same origin. Those who lose blood do not sweat, and those who lose sweat do not lose blood. The following formula is appended as a treatment method for bleeding caused by Cold.

Treating hematemesis (hematemesis, vomiting blood) caused by external Cold contraction and internal heat accumulation. Li Dongyuan treated a poor scholar who suffered from Spleen-Stomach deficiency. After recovering with tonifying herbs, he moved into a spacious, cold room and slept on a heated kang. He then developed hemoptysis (hemoptysis, coughing up blood) and hematemesis. Li Dongyuan stated that this was due to long-term weakness; living in a spacious room in winter with thin clothing further depleted his Yang. External severe Cold obstructed internal heat, preventing the Fire pathogen from dispersing, thus forcing blood out of the mouth. The treatment should tonify exterior Yang and drain interior deficient heat. Recalling Zhang Zhongjing’s treatment of Taiyang Cold damage with a floating-tight pulse, where failure to use Ma Huang Tang for sweating led to epistaxis (epistaxis, nosebleed), which was then cured immediately by Ma Huang Tang, Li found this case very similar. Thus, he formulated this decoction, which cured the patient after one dose.
Ren Shen (Ginseng Root) (Tonifies insufficient Yuan Qi in the Upper Jiao and consolidates the Middle); Mai Dong (Ophiopogon Tuber) (Protects Lung Qi); Gui Zhi (Cinnamon Twig) (Pungent and sweet to disperse Cold); Dang Gui (Angelica Sinensis Root) (Harmonizes and nourishes Qi and Blood); Ma Huang (Ephedra Herb) (Roots removed to disperse external Cold); Zhi Gan Cao (Prepared Licorice Root) (Harmonizes herb properties and tonifies Spleen); Huang Qi (Astragalus Root) (Assists Wei Qi to secure the exterior); Wu Wei Zi (Schisandra Fruit) (Preserves and astringes Lung Qi); Bai Shao Yao (White Peony Root) (Harmonizes Liver to restrain the acrid-warm nature of Ma Huang and Gui Zhi). Use three bowls of water. First, boil Ma Huang alone until boiling, skim off the foam, then add the remaining herbs. Simmer together until one bowl remains, strain, and take hot. One dose is sufficient for recovery; no second dose is needed.
This prescription acts on the Foot-Taiyang and Hand-Foot-Taiyin meridians. *Bencao Gangmu* states: "Observing this single formula is sufficient to serve as a model for ten thousand generations." It essentially combines half of Zhang Zhongjing’s Ma Huang Tang with half of a tonifying formula. For any deficient person requiring Zhang Zhongjing’s formulas, this should be the standard.

Only in cases of hematemesis and epistaxis caused by Summerheat, Liu Hejian’s method can be used to temporarily suppress excessive Yang. Ultimately, Summerheat damages the Heart. Since Heart Qi is deficient, Summerheat Qi takes advantage to enter. The Heart governs Blood, leading to hematemesis and epistaxis. Since the Heart is deficient and cannot govern Blood, it is inappropriate to excessively use Cold-Cooling herbs to drain Heart Fire. Instead, one must add Mu Dan Pi (Moutan Cortex) and Sheng Di Huang (Rehmannia Root) to Qing Shu Yi Qi Tang (Qing Shu Yi Qi Tang, Clear Summerheat and Boost Qi Decoction). Considering Summerheat also damages Qi, the patient will lack energy to move. Using Ren Shen and Mai Dong to boost Qi allows Qi to control Blood, avoiding complications.

In treating blood disorders, regulation before and after must follow the three meridians: the Heart governs Blood, the Spleen controls Blood, and the Liver stores Blood. Gui Pi Tang (Gui Pi Tang, Restore the Spleen Decoction) is the primary formula for these three meridians. Yuan Zhi (Polygala Root) and Suan Zao Ren (Ziziphus Seed) tonify the Liver to generate Heart Fire; Fu Shen (Poria with Hostwood) and Long Yan Rou (Longan Aril) tonify the Heart to generate Spleen Earth; Shen, Zhu, and Cao (Ginseng, Atractylodes, and Licorice) tonify the Spleen to secure Lung Qi; Mu Xiang (Aucklandia Root), being aromatic, enters the Spleen first. The overall goal is to return Blood to the Spleen, hence the name Gui Pi Tang. It is especially suitable for cases where depression/anger injures the Spleen or overthinking injures the Spleen. For excess Fire, add Shan Zhi Zi (Gardenia Fruit) and Mu Dan Pi; for deficient Fire, add Mu Dan Pi and Rou Gui (Cinnamon Bark). Ba Wei Wan (Eight-Ingredient Pill) is also used to cultivate the root of congenital constitution. There are no remaining methods of treatment.

Zhang Zhongjing stated in Shanghan Lun: "Erroneously inducing sweating in Shaoyin disturbs the meridian blood, leading to exhaustion below and reversal above, which is difficult to treat." Exhaustion below refers to Yin Blood depletion in the lower body. Reversal above refers to Yin Qi rebelling upward. Blood and Qi mutually support each other; without Blood, Qi scatters without control; without Qi, Blood coagulates and does not flow. Thus, when Yin Fire moves, Yin Qi must rush upward. As Yin Qi rushes upward, Yin Blood inevitably overflows from above, leading to depletion below. Once Blood overflows, the Qi accompanying it scatters in the chest and cannot return to its origin, causing reversal above. Yin Qi rebellion stops at the neck; it cannot reach the clear Yang position of the vertex. Hence, there is throat obstruction, palpitations, tinnitus, and chest discomfort. But is it merely obstruction and discomfort? When Yin Qi stays above for a long time, it inevitably triggers Long-Lei Fire (latent fire due to Yin deficiency) below. Bleeding will not stop until blood is exhausted, nor will Qi reversal stop until Qi is exhausted. This is why Zhang Zhongjing considers it difficult to treat. However, seeking a definitive treatment beyond standard methods, the primary principle is to strengthen the Yang Qi of the Spleen. Long-Lei Fire requires cloudy skies to rise; if the sky is clear, it retreats and remains still. Therefore, using Cold herbs to clear Fire is a common method of using Water to control Fire, but applied to Yin Fire, it only exacerbates the condition. Strengthening Spleen Yang has three benefits: First, strong Spleen Yang is like a clear sky, keeping Long-Lei Fire latent. Second, strong Spleen Yang aids digestion and transformation of essences, regenerating depleted lower Blood. Moreover, earth qi must evaporate into moisture before rising as clouds. If soil lacks evaporation, earth qi is isolated. Is the sky not often clear? All things take Earth as their root, and Yuan Qi takes Earth as its home. Can we neglect this?

Zhang Zhongjing said: "Strong Yin generates Yin Blood," meaning that when a person’s True Yang is vigorous, it naturally transforms and generates Yin Blood. Modern people do not understand this principle. Seeing only Yin Blood deficiency, they use Ren Shen and Huang Qi to tonify. Initially, after one or two doses, the Fire receives warm tonification and shows slight improvement, leading them to believe it is correct. Prolonged adherence to this formula反而 assists Fire pathogenic factors, causing cough, shortness of breath, and muscle wasting, often leading to critical danger and death, which is truly pitiable! Blood itself is not diseased; it perishes because Qi deficiency leaves it without support. Therefore, tonifying Qi restores Blood naturally. This is what is meant by "Strong Yang generates Yin Blood; without Yang, Yin cannot be generated."

Mr. Xue Lijia met a fortune teller, Zhang Donggu, discussing destiny. Walking out into the courtyard, Zhang vomited one or two mouthfuls of blood, stating he had this symptom for a long time, triggered by exertion. Mr. Xue said, "This is Lung Qi injury from overexertion; his blood must be scattered." Examination confirmed this. He prescribed Bu Zhong Yi Qi Tang (Bu Zhong Yi Qi Tang, Tonify the Middle and Augment Qi Decoction) plus Mai Dong, Wu Wei Zi, Shan Yao, Shu Di Huang, Fu Shen, and Yuan Zhi. The patient recovered. The next morning, Zhang requested an audience, saying, "After taking Si Wu Tang, Huang Lian, and Shan Zhi Zi, my bleeding increased and fatigue worsened. After taking your prescription for seven days, my hematemesis stopped instantly, and my spirit returned to normal. Why?" Mr. Xue replied, "The Spleen controls Blood, and the Lung governs Qi. Exertion injured the Spleen and Lung, causing blood to run recklessly. Therefore, I used the previous herbs to tonify Spleen and Lung Qi, guiding the blood back to its source."

The Lung is the canopy, the purest organ. Fire causes cough, and Phlegm causes su. The Lung governs Qi; Qi rebellion causes cough. The Kidney governs Water; Water flooding creates Phlegm. The Kidney Meridian enters the Lung, follows the throat, and its branch connects from the Lung to the Heart, belonging to the chest. Thus, when diseased, they affect each other. Scattered blood in saliva indicates blood from Kidney相火 (Ministerial Fire) flaming upward. Red threads coughed up with phlegm indicate blood from Lung collaterals damaged by Heat. White blood, pale red, resembling meat or lung tissue, indicates certain death. Saliva with blood, expectoration with blood or blood threads, belongs to the Kidney Meridian. Epistaxis and coughing blood belong to the Lung Meridian. Vomiting blood in basins or bowls belongs to the Stomach Meridian. Vomiting rising from the hypochondrium belongs to the Liver Meridian. Hematuria belongs to the Small Intestine and Bladder Meridians. Lower bleeding belongs to the Large Intestine Meridian. Gum bleeding belongs to Stomach-Kidney Deficient Fire. Tongue bleeding is called She Nu (tongue epistaxis). Sweat pore bleeding is called Ji Nu (muscle epistaxis), belonging to the Heart and Liver. Fright moving blood belongs to the Heart; anger moving blood belongs to the Liver; sorrow moving blood belongs to the Lung; worry moving blood belongs to the Spleen; exertion moving blood belongs to the Kidney.

Pediatric conditions require examining the congenital Qi of parents, with maternal Qi being particularly important. Conditions like wind-stroke, smallpox/rubella, and Kidney deficiency fever are primarily governed by maternal Qi. If the mother has Fire, the child will have Fire; if the mother’s Spleen is deficient, the child will have many Spleen diseases; if the mother’s Fire is weak, the child will suffer from childhood Kidney deficiency symptoms such as delayed tooth eruption, speech, and walking, open fontanelles, and Kidney malnutrition. These are all congenital insufficiencies. Early regulation and tonification can restore natural lifespan.

The Lung not only causes epistaxis but also hemoptysis and sputum-blood. The Stomach not only causes hematemesis but also the Liver can cause hematemesis. The Lung governs Qi, and the Liver stores Blood. When Liver Blood fails to store, chaotic Qi rebels from the hypochondrium. Ultimately, this is all blood from Kidney Water flaming upward with Ministerial Fire. The Kidney governs Water; Water transforms into fluids, becoming Phlegm, saliva, and Blood. The Kidney Meridian enters the Lung, follows the throat, clamps the tongue root, and its branch connects from the Lung to the Heart, pouring into the chest. Thus, when diseased, they affect each other. However, epistaxis comes from meridians, traveling the clear pathway; hematemesis comes from the Stomach, traveling the turbid pathway. The throat and pharynx are different tubes. Meridian blood circulates freely, following Qi. With urgent Fire Qi, it directly invades the clear pathway, reaches the brain, and exits the nose as epistaxis. If it does not exit the nose, it becomes coughing/sputtering blood, exiting the pharynx from the Lung orifice. Stomach blood is defensive blood, staying put and residing in the Stomach. If Stomach Qi is deficient and cannot control Blood, or is forced by Fire, it causes vomiting from the throat to the mouth. The heat in hematemesis is in the Fu organs; the heat in epistaxis is in the meridians. In miscellaneous diseases, epistaxis is interior heat; in Shanghan, epistaxis is exterior heat. Nowadays, upon seeing hematemesis or epistaxis, people immediately use Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction) as essential. Since the rhino is a water animal, it can divide water and connect to heaven. Nasal blood travels from the Ren and Du meridians to the vertex and into the nose. Only Rhino Horn can descend into Kidney Water, guiding Rehmannia’s Yin-nourishing properties up via the Kidney Meridian, making it symptomatic. It can be borrowed successfully for Yin deficiency with Fire hyperactivity causing hematemesis and coughing. However, it is unsuitable for Yang deficiency from labor or Spleen-Stomach deficiency.

For excess Heat, the tongue coating must be dry and scorched, even black, and the pulse must be forceful upon heavy pressure. (However, one must know that a dry, scorched-black tongue can also occur when there is no fire under the pot [Kidney Yang deficiency], preventing fluid distribution.) For false Heat, the tongue may have a white coating but will be slippery; the mouth may be thirsty but unable to drink, or drinking without wanting to swallow; the face may be red but the color delicate; the body may be restless, desiring to sit or lie in mud/water; the pulse will be empty upon heavy pressure. This is the differentiation.

Excessive alcohol consumption injuring the Stomach and causing hematemesis, emerging after vomiting, can be treated with Ge Hua Jie Xing Tang (Kudzu Flower Decoction for Sobering Up), adding Mu Dan Pi and doubling Huang Lian to assist. This disperses heat up and down; the alcohol disease heals, and so does the bleeding. Overeating roasted, fried, spicy, and hot foods causing upper Jiao heat congestion, chest/abdominal fullness/pain, and purple-black clotted blood can be treated with Tao Ren Cheng Qi Tang (Peach Kernel Decoction to Order the Qi) to guide it out via the large intestine. This is the method of removing firewood from under the cauldron. These are internal and external causes, not originating from the root, so Cold-Cooling and draining herbs can be used. It is said that blood exiting downward is smooth, while exiting upward is rebellious. For all conditions of blood overflow, leakage, and reckless movement, unless there is Spleen deficiency with diarrhea and emaciation, Da Huang (Rhubarb) vinegar decoction, mixed with Sheng Di Huang juice, Tao Ren paste, Mu Dan Pi, Dan Shen, E Jiao, Hei Jing Jie, Xuan Ming Fen, Chi Shao, and Dang Gui, should be used to break their锐气 (sharp momentum) and guide them downward via the large intestine, turning rebellion into smoothness, followed by differentiated treatment. One might ask: Is it appropriate to use purgatives after blood loss? Not knowing that once blood runs recklessly and loses its proper path, failing to remove stagnation and resolve stasis to turn rebellion into smoothness means accepting recklessness as normal, how can it be controlled? Consider women: sufficient menstrual blood forms the fetus; stored blood stores itself, generated blood generates itself. During childbirth, lochia goes, and new blood generates. Where is the stagnation? Ignoring this and using Fu Ling, Huang Lian, Gui Zhi, Huang Bai, assisting Si Wu Tang, will inevitably damage Qi and Blood and ruin the Spleen-Stomach. After blood descends, use Yi Yi Ren, Bai He, Mai Men Dong, fresh Di Gu Pi. For cough/thirst, add Pi Pa Ye, Wu Wei Zi, Sang Bai Pi. For phlegm, add Bei Mu. These are all mild in Qi and light in Flavor, the fundamental herbs of the West/Metal element. If exclusive tonification is needed, combine Di Huang and Mai Dong, herbs of the Metal-Water organs. Although books say blood-loss patients need purgatives to break blood, this applies only to the initial stage of stagnation/recklessness. It also says: Blood-loss patients must not be purged; this is a strict warning for after significant blood loss.

Yin deficiency conditions are mostly upper Heat and lower Cold. Initially, Cold-Cooling herbs provide relief in the Upper Jiao, but soon appetite decreases. Mistaking this for food stagnation, Shen Qu and Shan Zha are added. Prolonged use increases Heat, phlegm-cough, and irritability. Believing the medicine is insufficient, Cold-Cooling herbs are doubled, leading to thirst, diarrhea, and abdominal distension. Then, Zhi Ke and Fu Pi (Qi-moving herbs) are used. Is death not inevitable? Thus, coughing and hematemesis do not necessarily develop into consumption (tuberculosis). Unceasing use of Si Wu Tang, Zhi Mu, and Huang Bai leads to consumption. Chest fullness/distension does not necessarily develop into drum-distension. Unceasing use of Shan Zha and Shen Qu leads to drum-distension. Facial/ankle edema does not necessarily develop into water-swelling. Unceasing use of diuretics leads to water-swelling. Qi stagnation/chest oppression does not necessarily develop into dysphagia. Unceasing use of Qi-moving herbs leads to dysphagia. Beware!

Astringents can treat collapse, but Qi collapse uses Qi herbs, while Blood collapse uses Blood herbs and also Qi herbs, because Qi is the commander of Blood. Yang collapse involves hallucinations; Yin collapse involves blindness; this is Spirit collapse. Tonifying Yang and assisting Yin is required; astringents cannot contain this.

Danxi said: "Vomiting blood in bowls, even filling basins, is mostly Yang excess and Yin deficiency. Thus, blood cannot descend. Due to Fire flaming upward, it surges out. The pulse must be large and Kou (hollow). Large indicates Fever; Kou indicates Blood stagnation and loss. This mostly belongs to the Yangming Meridian because it is abundant in Qi and Blood."

There are three types of hematemesis: Nei Nu (internal epistaxis), Fei Ju (lung abscess), and Shang Wei (Stomach injury). Nei Nu: Bleeding resembles epistaxis but does not come from the nostrils. It originates near the Heart-Lung, flows into the Stomach, appearing like bean soup or clotted blood. Blood stagnates in the Stomach, causing fullness and vomiting, sometimes several dou to one shi. This results from fatigue and irregular diet. Fei Ju: Caused by heat-toxin congestion after drinking alcohol. Blood emerges after vomiting, ranging from one-half liang to one-sheng. Shang Wei: Occurs after overeating, when the Stomach is cold and cannot digest, causing irritability and forced vomiting. Food and Qi rush upward, tearing the Stomach, causing bright red blood and lower abdominal cramping. If spontaneous sweating occurs with a tight-numerous pulse, it is difficult to treat. Ancients said: In all blood-loss conditions, fever indicates death, cold indicates survival. This is a generalization; are there no cases of survival with fever and death with cold? One must consider pulse and symptoms together.

To treat blood disorders, one must seek herbs belonging to the Blood category, such as Si Wu Tang. Chuan Xiong is the Qi herb in Blood, entering the Liver Meridian; its pungent-dispersing nature moves Blood stagnation caused by Qi. Di Huang is the Blood herb in Blood, entering the Kidney Meridian; its cold nature tonifies True Yin deficiency. Dang Gui is the main Blood herb, entering the Liver Meridian; its pungent-warm nature has three uses depending on application; whole use activates Blood, returning it to its meridian. Shao Yao is a Yin-benefit herb, entering the Spleen Meridian; its sour-cold nature cools Blood and treats Blood-deficiency abdominal pain. This specifically discusses treating blood diseases by seeking Blood-category herbs. If Qi is deficient and Blood is weak, follow Zhang Zhongjing: tonify Blood deficiency with Ren Shen, as Strong Yang generates Yin Blood. Si Wu Tang alone addresses Blood-matrix injury when Qi is not deficient. Its assistants include: Tao Ren, Hong Hua, Su Mu, Xue Jie, Mu Dan Pi for Blood stagnation; Pu Huang, E Jiao, Di Yu, Bai Cao Shuang, Zong Tong Hui for Blood flooding; Ru Xiang, Mo Yao, Wu Ling Zhi, Ling Xiao Hua for Blood pain; Cong Rong, Suo Yang, Niu Xi, Gou Qi Zi, Yi Mu Cao, Bai Gui Ban for Blood deficiency; Dairy/blood products for Blood dryness; Gan Jiang for Blood cold; Sheng Di, Ku Shen for Blood heat. This outlines the general treatment to clarify Blood-category herbs. Can Si Jun Zi and Si Wu Tang exhaust the uses of Qi and Blood?

Coughing blood with phlegm is named Ke Xue (coughing blood). Causes are twofold: Heat congestion in the Lung is easy to treat, merely requiring dispersion. Chronic cough damaging the Lung is difficult to treat, indicating consumptive disease. Blood threads in phlegm indicate Yin deficiency with Fire hyperactivity and Lung injury from overwork. Although Blood is born in the Heart, controlled by the Spleen, and stored in the Liver, it is actually distributed by the Lung. Still, it returns to meridians; with Heat, it runs recklessly. Fire damages Lung collaterals, and blood follows cough. If accompanied by phlegm, it is Ke Xue; if expelled in large amounts, it is Tu Xue (hematemesis). If there is always a metallic taste in the throat, and blood spurts out upon spitting, fresh, purple, or fine particles, it is Luo Xue (spitting blood). If fresh red blood comes out with saliva, it is Tuo Xue (saliva blood). Both originate from the Kidney. There may also be internal blood stasis and Lung Qi congestion. If it can descend, saliva may be dark purple-black blood-water, like pig blood, dull and not fresh. Emaciation, body heat, and night sweats indicate constraint/depression. Tuo Xue is blamed on the Lower Jiao, caused by Yang Fire simmering and pressing. The Kidney governs saliva; the Foot-Shaoyin Meridian has little Blood and much Qi, making this condition difficult to treat. Luo Xue is also considered severe and difficult because the Hand-Taiyin Lung Meridian has much Qi and little Blood. The Lung is Metal, a clear-descending organ. When Metal is constrained by Fire and forced upward, it becomes Luo Xue, a severe rebellion.

The Classic says: "Upper Qi shows blood, lower sounds indicate disease," meaning wheezing with Luo Xue and coughing. Thus, although hematemesis, epistaxis, and lower bleeding may involve large losses, since they come from the Liver, Stomach, and Large Intestine—three meridians abundant in Qi and Blood—cool body and faint pulse are harmless. Ke Xue and Luo Xue come from the Heart, Lung, and Kidney—three meridians abundant in Qi and scarce in Blood. Much Qi generates Fire easily; little Blood makes Fire recognizable. Thus, gradually appearing洪-numerous pulse, fever, and cough mean that even slight blood loss often leads to death.

One formula treats persistent bleeding despite medication, indicating a hole in the Lung. Use Bai Ji powder and pig lungs, cooked and dipped in powder, eaten 3-4 times daily. The hole is filled by Bai Ji powder, and bleeding stops. To identify the organ of blood, spit into a water bowl: floating is Lung blood, sinking is Liver blood, half-floating/half-sinking is Heart blood. Based on observation, eat cooked sheep Lung/Liver/Heart dipped in Bai Ji powder. However, quiet rest and abstinence from desires are required for treatment. Ke Xue and Luo Xue are the worst conditions; initially subtle, they become incurable because they originate from the Heart and Lung.

Carrying heavy loads, being crushed, or walking far with weight, suddenly causing heart/chest pain and mouth/nose bleeding, commonly known as "Injury-force Hematemesis," is due to tearing of the inner mucosa of the Lung and Stomach. Using Cold herbs will suppress more and bleed more, eventually leading to Stomach damage, cough, and death. Immediately use Ren Shen fine powder, Fei Luo Mian (fine flour), and Tong Bian (child's urine) mixed and taken orally. Or Bai Ji powder with Tong Bian. Do not use Cold herbs.

All blood-loss conditions show a Kou pulse. Verify the source based on location. Generally, blood-loss pulses should be deep and fine. If floating and large, prognosis is poor later.