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42. Hematemesis in cold damage (Shanghan) often results from therapeutic contraindications; if there is cold reversal in the lower jiao and exhaustion of yin blood in the upper jiao, it involves the Shaoyin channel. For excessive heat in the three yang channels, clearing and resolving is appropriate. If blood stasis causes chest fullness and pain, purgation to remove stasis is indicated. Sudden vomiting of foul-smelling blood indicates internal ulceration and carries a fatal prognosis. Excessive bleeding leading to blood depletion presents with a pale complexion lacking ruddy color. In such cases, Rhinoceros Horn (Xijiao) and Peach Kernel (Taoren) may be selected. To rescue from depletion, Shengyu Decoction is used for mild cases, and Renshen Yangrong Decoction (Ginseng and Nutritive Qi Nourishing Decoction) for severe cases.

[Note] Hematemesis caused by cold damage arises from failure to induce sweating or purge, or from therapeutic reversals (such as moxibustion errors), leading to rampant pathogenic heat that boils and disturbs the blood in the meridians. If blood flows from the mouth, nose, ears, and eyes, accompanied by difficult urination, this is due to forcibly inducing sweat in patients with Shaoyin disease, termed "lower reversal and upper exhaustion," which is difficult to treat. For hematemesis due to excessive heat in the three yang channels, Shengma Gegen Tang (Bupleurum and Kudzu Root Decoction) combined with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is suitable. If heat is extreme, add Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) to clear and resolve. If blood stasis is present, causing chest fullness or pain, Taoren Chengqi Tang (Peach Kernel and Magnolia Bark Decoction) combined with Xijiao Dihuang Tang should be used to purge. Sudden vomiting of foul-smelling blood is termed "internal ulceration," which is fatal. Excessive bleeding resulting in loss of red color on the face and lips is termed "blood depletion." For rescuing from depletion, Shengyu Tang is used for mild cases, and Renshen Yangrong Tang for severe cases.

43. Heat in the Bladder causing hematuria is best treated with Bazheng San or Daochi San to promote diuresis and clear heat. Heat and stasis binding in the interior, presenting with tenesmus and passage of pus and blood, are treated with Huanglian Ejiao Tang, Baitouweng Tang, or Taohua Tang.

[Note] Heat from the yang channels descending into the Bladder damages the Ying level. If heat is slight and blood abundant, stasis forms leading to blood accumulation. If heat is abundant and blood slight, heat forces blood to move; unable to accumulate, it escapes through the lower orifices, causing hematuria. This is treated with Bazheng San and Daochi San to promote diuresis and clear heat. Heat from the yin channels shifting to force the Yangming channel damages the Ying level. If stasis forms, it leads to blood accumulation, manifesting as forgetfulness or mania-like states. If no accumulation occurs, hematochezia results; if heat rots flesh, pus is passed. Passage of pus and blood with heat stagnation inevitably leads to tenesmus. Mild cases are treated with Huanglian Ejiao Tang; severe cases with Baitouweng Tang to clear heat. If there is slipping and incontinence, Taohua Tang is used to astringe.