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Treats hemoptysis (coughing up blood), and also treats hematemesis (vomiting blood) and epistaxis (nosebleed); resolves blood stasis, and treats bleeding from the lower orifices (hematochezia and hematuria).
*Huarui Shi* (Calcined Pyrite, 3 qian, charred but retaining its nature) *Sanqi* (Notoginseng Radix, 2 qian) *Xueyu* (Carbonized Human Hair, 1 qian, charred but retaining its nature)
Grind all together into a fine powder. Divide into two doses. Take with warm boiled water.

Physicians of the world often claim that *Sanqi* is a powerful medicine for stopping hematemesis and epistaxis, and should not be used lightly; this is incorrect. Essentially, both *Sanqi* and *Huarui Shi* are sacred medicines for stopping bleeding, and equally sacred medicines for transforming blood stasis. Moreover, they resolve blood stasis without damaging new blood. When used to treat hematemesis and epistaxis, there will surely be no other complications after recovery. I have derived this from repeated clinical experience, so I dare to state it definitively. Even using *Sanqi* alone, 4–5 qian or even up to 1 liang, is effective for treating hematemesis, epistaxis, and bleeding from the large and small intestines. Frequent use can also treat amenorrhea due to blood stasis forming masses in women. As for *Xueyu*, its power to resolve blood stasis is inferior to that of *Huarui Shi* and *Sanqi*, but its benefit in nourishing blood surpasses them. This is because it originates from human blood, has the ability to self-reduce and transform, and when carbonized, possesses hemostatic properties.

I once treated a fifteen-year-old boy who had been passing blood in his stool for several months without improvement. The excrement resembled rotten roasted meat mixed with oily membranes. Physicians dismissed it as incurable. Later, upon examining his pulse, I found it wiry, rapid, and weak. I prescribed him porridge made from raw *Shanyao* (Dioscoreae Rhizoma) ground finely, mixed with 6–7 fen of *Xueyu Tan* (Carbonized Human Hair). He took this twice daily and was completely cured within ten days.

For patients with chronic hemoptysis or hematemesis that does not heal:
*Sheng Longgu* (Raw Os Draconis, 1 liang, crushed to fine powder) *Sheng Muli* (Raw Concha Ostreae, 1 liang, crushed to fine powder) *Yurou* (Fructus Corni, 1 liang, pits removed) *Sanqi* (Radix Notoginseng, 2 qian, ground to fine powder, taken with decoction liquid)
If bleeding continues after taking this formula, add 5–6 qian of fine powder of *Zhe Shi* (Ochre).

Zhang Jingyue stated: "Chronic cough damages the collaterals in the lungs, causing the patient to cough up blood." Western medicine states: Damage and rupture of blood vessels in the stomach cause hematemesis. *Longgu*, *Muli*, and *Yurou* possess astringent properties but also have opening/unblocking capabilities (the properties of these three herbs are detailed under Jiji Tang, Laifu Tang, Liyu Shengxian Tang, and Qingdai Tang). Therefore, they can tonify lung collaterals and gastric blood vessels, achieving hemostasis, without the risk of abrupt cessation leading to retained blood stasis. *Sanqi* is added as an assistant herb to take advantage of its ability to eliminate necrotic tissue and promote regeneration, facilitating healing of damaged areas. Its nature is good at regulating blood, making it an excellent product for treating epistaxis.

It is common knowledge that the origin of hemoptysis lies in the lungs, while the origin of hematemesis lies in the stomach. Western medicine discusses hematemesis in particular detail. Their theory posits that there are many veins in the stomach; if one or two rupture, bleeding occurs. This may be due to inflammation in the stomach itself corroding the vessels, or due to external trauma causing vessel rupture. Such blood is brown-black and foul-smelling, dangerous and difficult to treat, but such cases are rare. Commonly observed cases involve vessels that have not ruptured, yet blood oozes from the vessel walls. This blood is often dark. Since venous blood is originally purple-black, and gastric acid turns it black further. However, if blood oozes from gastric vessels and is vomited immediately, it can appear bright red. Etiology includes stomach disease or general weakness with thin blood quality. There are cases where the stomach itself is not diseased, but blood enters from other meridians, such as retrograde menstruation (daojing), where uterine blood enters the stomach. Also, hepatosplenomegaly impedes blood flow, causing venous engorgement; blood entering the stomach causes vomiting, while blood entering the intestines causes defecation. Although the pathways differ, the underlying principle is the same.

Question: The *Neijing* states: "Yangming reversal leads to hematemesis and epistaxis." Western medicine states: "Rupture of gastric blood vessels leads to hematemesis." Are these two theories compatible? Answer: Yangming reversal implies distension of Qi and Blood in the stomach fu-organ, which makes vessels prone to rupture. Lowering the rebellious Qi allows ruptured vessels to close naturally. If they do not close, use astringents like *Longgu* and *Muli* to repair and prevent ulceration, assisted by flesh-regenerating agents like *Sanqi*, *Ruxiang* (Boswelliae Resina), and *Moyao* (Commiphora Resina). This explains the efficacy of my proposed Buluo Buguan Tang. If Yangming has not reversed, but gastric vessels rupture due to other causes, blood in the stomach often descends with food and exits via stool, rather than being vomited.

This original formula did not contain *Sanqi*; it contained 1.5 qian each of *Ruxiang* and *Moyao*. Upon discussing this with a friend, Mr. X, he said: "When I treat hematemesis, I also use your Buluo Buguan Tang, substituting *Sanqi* for *Ruxiang* and *Moyao*, resulting in faster efficacy." I happily adopted this modification.

Mr. X further stated: "*Longgu* and *Muli* can constrain ascending heat and guide it downward; ascending blood follows this path back to its channels. *Yurou* is an excellent liver-tonifying herb, essential for hematemesis caused by liver injury. Moreover, the functions of *Longgu* and *Muli* are profoundly mysterious. Even in cases of extreme pulse deficiency where daily tonics fail, or in patients too deficient to tolerate tonics, administering large doses of *Longgu* and *Muli* yields immediate results. I do not know why this is so." I replied: The essence of Yang in the human body is Hun (Ethereal Soul), and the essence of Yin is Po (Corporeal Soul). *Longgu* calms Hun, and *Muli* strengthens Po. When Hun and Po are calm and strong, Spirit (Jingshen) becomes sufficient, and deficiency heals naturally. Thus, *Longgu* and *Muli* are indeed miraculous medicines for tonifying Hun, Po, and Jingshen.

A resident of the county suffered from chronic hematemesis. An old physician surnamed X treated him with a heavy dose of 2 liang of *Chishizhi* (Halloysitum Rubrum) combined with other hemostatics, curing him in one dose. Later, his son Mr. X recounted this to me and asked about the rationale for the heavy dose of *Chishizhi*. His son answered: "Most hematemesis is due to deficient fire ascending. Just as fire in a stove rises more vigorously when the base is empty, using heavy *Chishizhi* fills the Lower Jiao, preventing deficient fire from ascending." I said: "Your reasoning is good, but incomplete. *Chishizhi* has a heavy-sinking property similar to *Zhe Shi*, allowing it to direct rebellious Chong and Stomach Qi downward. Its sticky-astringent property is similar to *Longgu* and *Muli*, enabling it to repair ruptured blood vessels. Only by understanding both aspects can one fully appreciate the subtlety of using heavy *Chishizhi*. Therefore, in cases of internal injury from external trauma, such as prolonged hematemesis from bruising, where I suspect gastric vessel damage, I modify Buluo Buguan Tang by removing *Yurou* and changing the decoction to a powder, taken in divided doses. In this form, *Longgu* and *Muli* possess not only astringent power but also greater heavy-sinking power than in decoctions, leading to rapid cure of hematemesis." The son replied joyfully: "My father used this formula when I was young, and I did not ask for details. Today, your words have bestowed great benefit upon me."

I once treated a young woman from the Ma family in Cangzhou who had suffered from hemoptysis for three years with no effect from various medicines. Although she occasionally improved, the condition quickly relapsed. Upon examination, I noted night sweats. I prescribed 1 liang each of purified *Yurou*, raw *Longgu*, and raw *Muli* to be decocted and taken. My intention was to stop the sweating first. Indeed, one dose stopped the sweat, and a second dose cured the hemoptysis. Previously, her chronic hemoptysis was due to ruptures in lung collaterals or gastric vessels. The combination of *Yurou*, *Longgu*, and *Muli* provided astringency and consolidation, thereby resolving the bleeding.

I also treated my cousin Zhang from the same village, aged thirty, who vomited blood every ten to twelve days, progressing to daily episodes despite multiple treatments. His pulse was nearly normal but slightly hollow (Kou pulse). I treated him with this formula, and he was completely cured in three doses. Later, I added 3 qian of fine *Sanqi* powder to this formula, taken with the decoction, for treating chronic hemoptysis and hematemesis. It proved effective almost immediately. For severe hematemesis, adding 5–6 qian of *Zhe Shi* to the first three ingredients of the decoction, taken with *Sanqi* powder, is even more effective.

A poor laborer surnamed Zhang in the county pulled a cart for long distances. Due to excessive effort on an empty stomach, he began vomiting large amounts of blood. Bedridden in an inn, fearing death and lacking funds to return home, he walked slowly. During the journey, he continued vomiting blood, experiencing dizziness, palpitations, and difficulty walking. Hungry but unable to swallow dry biscuits from his pocket, he accidentally found over a dozen hawthorn fruits (*Shanzha*). He ate them with the biscuit and felt his spirit instantly refresh; the illness miraculously healed. Sour flavors can astringe, and *Shanzha* possesses astringent properties combined with blood-stasis-resolving power. This aligns with the principle of Buluo Buguan Tang, yielding this unexpected result.

Appendix:
Letter from Cai XX, Chongming County, Jiangsu:
Recalling my time graduating from middle school, excessive mental exertion led to hematemesis. Despite my family's lineage of physicians, it remained incurable. Seeking famous doctors yielded only intermittent remission. During university, the condition worsened. Doctors advised dropping out to rest. I complied, resting and taking medicine, but the illness persisted. Desperate, I studied ancestral medical texts, but they were vast and confusing, mixing jade with stone. Fortunately, this autumn I purchased *Zhongzhong Canxi Lu* from Mr. Zhou Xiaonong. Reading about Buluo Buguan Tang for hematemesis/epistaxis, I recognized it as the correct formula for my condition. I showed it to my grandfather, who halved the dosage for decoction. It showed significant effect. Emboldened, I followed the original formula, incorporating the principle of Hanjiang Tang by adding 6 qian of *Zhe Shi*. After three doses, I was completely cured. Previously, I relapsed every half month; now, over a month later, I am safe, feeling stronger and more energetic.