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The pathway of blood generation originates from the Middle Jiao (Middle Burner). The *Neijing* states: "The Middle Jiao receives Qi and extracts essences, transforms them into red, which is called Blood."
Blood flow is rooted in the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel), irrigating the body centrally. Half of the flowing blood travels along the meridians with the Chong and Ren vessels.
It warms the muscles and couli (interstices), freely circulating externally. The other half of the flowing blood disperses outside the vessels to nourish the muscles, couli, and skin/hair.
When invaded by the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire), the pathways of the meridians are shaken. The "Six Excesses" refer to Wind, Cold, Summerheat, Dampness, Dryness, and Fire. "Jing" refers to the constant path; "Dao" refers to the route. This means the usual routes where blood flows; when injured by external pathogens, these routes become disturbed.
Appropriate treatment involves releasing the exterior and dispersing, referencing Mahuang Renshen Shaoyao Tang (Ephedra, Ginseng, and Peony Decoction). For bleeding caused by external injuries, exterior-releasing and dispersing methods are suitable. Li Dongyuan treated a patient who had internal deficiency-heat and external severe cold invasion resulting in hematemesis. Following Zhang Zhongjing's method, he added tonifying agents to Mahuang Tang (Ephedra Decoction), naming it Mahuang Renshen Shaoyao Tang, which cured the patient after one dose.
Diseases caused by the Seven Emotions (Joy, Anger, Sorrow, Fear, Love, Dislike, Desire) cause bleeding like surging tides. The movement of the Seven Emotions arises from the Five Wills (emotional activities associated with the Zang organs). Medical texts often state that each Zang organ has its own ministerial fire; when stimulated by the Five Wills, the fire moves, causing blood to overflow following the fire. However, if the Five Wills are injured for a long time, the fire becomes deficient fire, and sweet-warm methods should be used.
Guidance and retention methods use Gancao (Licorice Root) and Ganjiang (Dried Ginger) to harmonize. Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) is miraculous, or add two qian of Wuweizi (Schisandra Berry). If fire is excessive, add three qian of Sangbaipi (Mulberry Bark) and one liang of Xiaomai (Wheat). Contemporary physicians, citing the concept of "guiding blood back to the Spleen" in Guipi Tang (Restore the Spleen Decoction), claim that guiding blood to the Spleen is equivalent to returning blood to the vessels. One must ask: how large is the Spleen? Can it hold buckets or basins of blood leaving the vessels, returning them entirely inside without rupture? While quack doctors are beyond discussion, even those proud of being famous doctors fall into this error, which is truly lamentable!
Warmth and retention methods are profound in principle. Lizhong Tang (Regulate the Middle Decoction) with Muxiang (Aucklandia Root) and Danggui (Angelica Sinensis) decocted and taken orally. For any hematemesis where taking cooling and moistening medicines worsens the condition, and there are external signs of cold, this indicates Yang deficiency with Yin/Blood leakage; this formula is essential. When blood is warmed, it circulates normally in the meridians. This method comes from *Renzhai Zhizhi Fang*.
Cooling and purging methods eliminate stasis. If fire is excessive and the pulse is洪大 (surging and forceful), cooling agents are indispensable. However, nowadays, in treating blood diseases, people often use Oujie (Lotus Node), Heizhi (Charred Gardenia), Baiji (Bletilla Rhizome), and old ink to stop bleeding, causing stasis to remain unresolved, laying the foundation for cough and consumptive disease. Xie Xin Tang (Drain the Heart Decoction) in the *Jinkui Yaolue* uses twice as much Dahuang (Rhubarb Root) as Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome); this is using cold to move stasis. Baixie Tang (Artemisia Leaf Decoction) treats persistent hematemesis; this is using warmth to move stasis. These two formulas form a pair of warm and cold treatments.
Chidou San (Red Bean Powder) addresses the manifestation of lower blood loss. Blood appearing before stool is called "near blood"; the *Jinkui Yaolue* uses Danggui Chixiaodou San (Angelica and Red Bean Powder).
If using Huangtu Tang (Yellow Earth Decoction), it is truly ingenious. Blood appearing after stool is called "far blood"; the *Jinkui Yaolue* uses Huangtu Tang.
For all types of bleeding, this formula is versatile. Huangtu Tang is not only for far blood. It can treat hematemesis, epistaxis, hematochezia, hematuria, uterine bleeding (blood flooding), and chronic bloody dysentery. By warming the central palace (Spleen/Stomach) and earth organs, and mutually assisting with cold and hot substances, every step conforms to the principles.
The Five Zang organs have blood; the Six Fu organs do not. Observing dissected animal abdomens, below the heart and flanking the spine, the Pericardium contains much blood, the Liver contains much blood, and the Heart, Spleen, Lungs, and Kidneys each contain blood, while the Six Fu organs lack blood. Recently, some claim that massive hematemesis is vomiting stomach blood, which is an error derived from mishearing ancient doctors. Vomiting blood from the Five Zang organs invariably leads to death. As for hematemesis, epistaxis, and lower bleeding, these are all blood from the dispersed circulation of the meridians.