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Treatment for hematemesis (vomiting blood) and epistaxis (nosebleed), where the pulse is surging, slippery, and long, or rises to reach the thenar eminence (Yuji area of the palm). This is caused by heat leading to the failure of Stomach Qi to descend. Using heavy, cold, and descending herbs to lower the Stomach Qi will stop the bleeding.

Raw Hematite (Lithodis, Shi Gao) [6 qian, crushed]
Clear Pinellia Rhizome (Ban Xia) [3 qian]
Trichosanthes Seed (Gua Lou Ren) [4 qian, stir-fried and crushed]
Raw White Peony Root (Bai Shao) [4 qian]
Bamboo Shavings (Zhu Ru) [3 qian]
Arnebiae Radix seu Lithospermi Semen (Niu Bang Zi) [3 qian, stir-fried and crushed]
Powdered Licorice Root (Gan Cao) [1.5 qian]

In *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), there is the Xie Xin Tang (Drain the Epigastrium Decoction) for treating heart Qi deficiency manifesting as hematemesis and epistaxis, which uses Rhubarb (Da Huang) combined with Scutellaria Root (Huang Lian) and Scutellaria Root (Huang Qin). Later generations failed to grasp Zhang Zhongjing's intent in formulating this prescription and often misunderstood it. They did not realize that the so-called "heart Qi deficiency" is not a true deficiency; if it were truly deficient, why would one use draining methods? Essentially, this condition arises from heat in the Yangming Stomach fu-organ reversing upward and rushing into the Heart, causing palpitations and restlessness, presenting an appearance similar to deficiency. Zhang Zhongjing established his theory from a superficial perspective to facilitate understanding, thus naming it "heart Qi deficiency." Therefore, his prescription strictly follows the principle in *Nei Jing* (The Inner Canon) that hematemesis and epistaxis are primarily attributed to the failure of Yangming to descend. He used Rhubarb to directly enter the Yangming fu-organ to drain the rebellious heat; used Scutellaria Root to clear Lung Metal heat, allowing its purifying and descending qi to assist the descending force of Yangming; and used Coptis Rhizome (Huang Lian) to clear Heart Fire heat, preserving the primal Yang and protecting the true Yin fluids of Shaoyin. Thus, "draining" is actually "tonifying." Moreover, Coptis Rhizome has the property of thickening the intestines and stopping diarrhea. When used with Rhubarb, it retains Rhubarb's power, preventing excessive loose stools. Therefore, for hematemesis and epistaxis not caused by cold, this prescription brings about immediate recovery. Furthermore, after recovery, all stasis dissipates, leaving no other ailments; it is indeed an excellent prescription. Even if the Heart Qi were truly deficient, and continuous bleeding posed an immediate life-threatening danger, using Xie Xin Tang first to stop the bleeding, followed by gradual tonification to restore healthy Qi, exemplifies the principle of "treating the acute symptoms first," which is also a sound strategy for physicians. However, people generally fear the potent nature of Rhubarb and dare not use it lightly; even when used, patients often react with shock and doubt. Consequently, I reluctantly formulated this Han Jiang Tang (Cold Descending Decoction), heavily utilizing Raw Hematite to replace Rhubarb's descending power. Repeated use has yielded prompt results.

One might ask: Later materia medica states that Ban Xia (Pinellia Rhizome) is contraindicated in blood disorders due to its acrid and drying nature. In your proposed Han Jiang Tang, which treats hematemesis and epistaxis caused by heat, why do you still include Ban Xia? Are you not concerned that its acrid dryness will damage the blood? The answer is: Blood disorders require differentiation. If it is consumptive cough with blood-streaked sputum, Ban Xia is indeed contraindicated. However, if there is massive hematemesis or unceasing epistaxis, even in consumptive cases, Ban Xia can be temporarily used to achieve immediate effect. After the bleeding stops, other treatments can be planned gradually. Generally, hematemesis is mostly due to Stomach Qi carrying Chong Qi (Penetrating Vessel Qi) rebelling upward; epistaxis is mostly due to Stomach and Chong Qi rebelling upward, forcing Lung Qi to rebel as well. *Nei Jing · Jue Lun Pian* (Treatise on Rebellious Qi) states: "Yangming rebellious qi leads to panting, cough, body heat, fright, epistaxis, and vomiting blood." This is a glorious sage teaching, immutable through the ages. Therefore, treating hematemesis and epistaxis should primarily focus on descending Yangming rebellious qi. Among herbs that descend Stomach Qi rebellion, none is superior to Ban Xia.

A boy, aged fourteen, suddenly began vomiting blood continuously for a day and night, in a critical state. Upon examination, his pulse was surging, long, and particularly forceful upon deep pressure on the right side. I determined that Stomach Qi failed to descend due to heat, and blood rose with the rebellious qi. I prescribed this decoction. One dose cured him; a second dose normalized the pulse.

An eighteen-year-old man occasionally suffered from hematemesis, initially mild. Due to medical error, he began massive, unceasing vomiting of blood. His pulse felt like floating hemp seeds on water, indistinguishable in rate, indicating extreme weakness. Without immediate medication to stop the bleeding, death was imminent. I administered this decoction, removing Zhu Ru (Bamboo Shavings), adding raw Dioscorea Rhizome (Shan Yao) 1 liang, and increasing Hematite (Dai Zhe Shi) to 8 qian. One dose stopped the bleeding. On re-examination, the pulse was imperceptible on both sides, even upon deep pressure. I was startled. He reported feeling mentally stable but physically weak and sore. I recalled Lü Cangzhou treating a case of macular eruption where all six pulses were absent. Lü stated: "The pulse is the wave of blood. Now, due to the eruption damaging blood, the blood cannot generate waves, hence the absence of pulse. Once the eruption subsides, the pulse will emerge." I used Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) to resolve the eruption toxin, and the pulse indeed emerged (see detailed case under Qing Yu Tang). In this case, massive blood loss from vomiting was more severe than blood damage from eruption. The absence of pulse upon deep pressure might be due to extreme deficiency in the blood level, unable to generate waves? Or perhaps during the vomiting, the pulse felt like floating hemp seeds because rebellious qi and flourishing fire forced the pulse to manifest externally? Alternatively, hearing that he traveled ten li home and vomited repeatedly along the way, could excessive blood loss during the journey be the cause? After much hesitation, I boldly administered a large dose of Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), reducing Poria (Fu Ling) and Alisma Rhizome (Ze Xie) by two-thirds, and adding Ginseng (Ren Shen) and Hematite (Dai Zhe Shi) several qian each. One dose brought out the pulse. After taking twenty-plus doses of mild tonifying medicine, he fully recovered.

Note: Both cold and heat can cause Stomach Qi to fail to descend. However, while many know that heat causes this, few understand that cold can also cause it. Mr. Huang's discussion on Stomach Qi failure focuses exclusively on cold, likely based on specific experiences. I once treated a young woman with upper jiao irritability and heat, inability to eat, frequent coughing up of thin saliva, and a wiry, fine, and powerless pulse. I diagnosed spleen-stomach damp-cold failing to transform and transport food downward, leading to retained fluid pathology. She reported that initially, due to cough and poor appetite, a local famous doctor prescribed Trichosanthes Root (Gua Lou), Fritillaria Bulb (Bei Mu), and Ophiopogon Tuber (Mai Dong). Her condition improved then relapsed. After a month of medication, she reached this state. I prescribed Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Glycyrrhiza Decoction) with added Dried Ginger (Gan Jiang) and Pinellia Rhizome (Ban Xia) (see postscript of Li Yin Tang for details), explaining the rationale carefully. However, upon my return, her family dared not administer the medicine and consulted the previous doctor. She died after another month. This illustrates how so-called "famous doctors" prescribe medicines. Why do they not read Mr. Huang's treatises and reflect upon themselves?

My disciple Gao XX experimentally tested a formula: Equal parts of Hematite (Dai Zhe Shi) and Talcum (Hua Shi) ground into fine powder. Taken with fresh well-water in hot weather, or boiled water in cold weather, dosage 1–2 liang. It is very effective for hematemesis and epistaxis caused by heat. Gao XX also treated a severe hematemesis case in Baoyang where other medicines failed. The pulse was floating, surging, slightly rapid, and empty upon deep pressure. Initially, I prescribed my Bao Yuan Han Jiang Tang (Protective Origin Cold Descending Decoction), which showed slight effect but relapsed. Gao XX then boldly administered Hematite 2 liang, Codonopsis Root (Tai Shen) 6 qian, and Raw White Peony Root 1 liang. One dose resulted in cure.

Appendix:
Letter from Zhang XX of Qing County, Zhili:
Cao XX of Tianjin, aged 25, suffered from intermittent hematemesis since spring, ignoring it. In mid-winter, the bleeding became severe, accompanied by hoarseness, anemia, chest irritability, poor appetite, and fatigue. Multiple treatments failed. Left pulse was fine and weak; right pulse was wiry and forceful. I diagnosed chronic illness generating heat, causing Stomach Qi to rebel upward due to heat, dragging blood with it. I prescribed Han Jiang Tang. For hoarseness, I added Fritillaria Bulb (Chuan Bei Mu) 3 qian. Two doses significantly reduced symptoms. Two more doses stopped the bleeding and cured the cough and hoarseness.

Letter from Wu XX of Dangyang, Anhui:
On the 23rd day of early summer, under scorching sun, Tao XX, a merchant, went out to buy grain. In the afternoon, he suddenly vomited blood on the road and continued vomiting upon returning home. He sought treatment at dawn. Pulse was surging, slippery, and solid upon deep pressure, indicating heat forcing Stomach Qi to fail to descend. Since the master praised Jin Gui Xie Xin Tang as an excellent prescription for hematemesis and epistaxis, I advised using that decoction taken with 2 qian of finely ground Black Gardenia Fruit (Hei Shan Zhi). Symptoms improved slightly, but bleeding persisted. Pulse remained forceful. I then prescribed Han Jiang Tang with 3 qian of finely ground Panax Notoginseng Root (San Qi). The patient took the decoction in two portions, swallowing the San Qi powder with each. One dose resulted in a cure.