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2. After hemorrhage, if the body is cool and the pulse is fine and weak, it indicates a favorable prognosis; if the pulse is large and rapid, the body is hot, and lying flat is difficult, it indicates an ominous prognosis. If blood gushes from the mouth and nose without stopping, and the internal tissues rot and emit a foul odor resembling decaying flesh, life is likely to be lost.
【Note】"Large and rapid" refers to a pulse that is both large and fast. "Difficulty lying down" refers to the inability to lie flat. "Major epistaxis/hematemesis" and "profuse bleeding" refer to blood flowing out like a spring without stopping, with internal tissue decay producing an odor similar to that of a corpse; at this stage, life is in peril.

3. When Yang hyperactivity invades Yin, heat forces blood to move recklessly; when blood invades the Qi level and fails to return to the meridians; when blood disease affects the Fu organs, it seeps into the turbid pathways; when originating from Zang organ disease, it overflows through the clear pathways. Hemorrhage caused by heat injury should be treated by clearing heat; hemorrhage caused by labor injury should be treated by regulating damage to restore balance; initial internal injury caused by strain (overexertion) should be treated by breaking stasis and expelling blood; chronic cases are treated similarly to labor injuries.
【Note】In all cases of hemorrhage, if Yang excess invades Yin, blood is forced by heat, cannot remain safely within the vessels, moves recklessly in the Qi level, and fails to return to the meridians. If blood disease affects the Fu organs, blood seeps into the turbid pathways such as the intestines and stomach, exiting upwards from the throat or downwards via urination and defecation. If blood disease affects the Zang organs, blood overflows from the clear pathways in the chest, exiting upwards from the larynx or downwards via the essence orifices. Blood normally circulates within the Zang and Fu organs inside the vessels, invisible outside the body; unless there is injury, it does not cause disease. There are three ways injury occurs: one is heat injury, best treated primarily by clearing heat; one is labor injury, best treated primarily by regulating damage; one is strain injury, initially best treated by breaking stasis and expelling blood, but chronically also treated by regulating damage.
Rhinoceros Horn and Rehmannia Decoction (Xijiao Dihuang Tang)

4. All hemorrhagic diseases caused by heat injury are suitable for Rhinoceros Horn and Rehmannia Decoction plus Paeonia and Moutan Cortex. If accompanied by fullness and pain in the chest and diaphragm, add Peach Kernel and Rhubarb; if heat is severe causing hematemesis or epistaxis, add Scutellaria and Coptis; if anger causes vomiting of blood, add Bupleurum and fried Gardenia; for spitting blood, add Scrophularia, Anemarrhena, and Phellodendron decocted; for coughing up blood, add Asparagus and Ophiopogon; for bloody sputum/cough, add Anemarrhena and Fritillaria; for phlegm obstruction with shortness of breath and cough, use Curcuma Pill.
【Note】All hemorrhagic diseases caused by heat injury are suitable for Rhinoceros Horn and Rehmannia Decoction. If there is fullness and pain in the chest and diaphragm, indicating blood stasis, add Peach Kernel and Rhubarb. If hematemesis is due to severe heat, add Scutellaria and Coptis. For hematemesis and vomiting of blood caused by anger, add Bupleurum and fried Gardenia. For spitting blood, add Scrophularia, Phellodendron, and Anemarrhena. For coughing up blood, add Asparagus and Ophiopogon. For bloody cough, add Anemarrhena and Fritillaria. For phlegm obstruction, shortness of breath, and paroxysmal urgent cough with blood, Curcuma Pill is suitable; the formula is provided later.
Modified Lung-Protecting Decoction (Jiufei Yin) plus Curcuma Decoction (Yujin Tang)

5. For labor-induced hematemesis, use Lung-Protecting Decoction; for bloody cough, use Modified Curcuma Decoction. If the physique is depleted, without heat signs, and Qi and Blood are weak, Ren Shen Yang Rong Tang plus Ophiopogon is effective.
【Note】Lung-Protecting Decoction refers to the Modified Lung-Protecting Decoction from the Consumption chapter, added with Curcuma powder. If Qi and Blood are weak without fire signs, Ren Shen Yang Rong Tang plus Ophiopogon is suitable.
Ligusticum and Angelica Decoction (Xiong Gui Yin)

6. After a full meal, exertion or carrying heavy loads may strain and rupture collaterals, causing blood to leave the meridians; Ligusticum and Angelica Decoction should be used to guide blood back to the meridians. It is also suitable for vomiting fresh blood with a gurgling sound and rebellious Qi, or for massive hematemesis due to falls, blows, or fractures involving blood stasis.
【Note】Exertion after a full meal, or straining while carrying heavy objects, can damage collaterals, leading to profuse bleeding and vomiting; Ligusticum and Angelica Decoction is suitable to guide blood back to the meridians. It is also suitable for vomiting fresh blood, falls, blows, or fractures that damage collaterals and cause massive hematemesis. If there is blood stasis, Rhubarb can be added to purge, or Peach Kernel and Safflower to break stasis, or Curcuma and Yellow Wine to promote circulation.
Ginseng and Rehmannia Decoction (Shen Di Jian)

7. Ginseng and Raw Rehmannia are used for persistent epistaxis and hematemesis. Heat decreases with blood loss, but Qi also perishes with blood loss. For Qi deficiency, Ginseng is the sovereign herb; for Blood heat, Raw Rehmannia is the sovereign herb.
【Note】Ginseng and Rehmannia Decoction consists of Ginseng and Raw Rehmannia. In cases of persistent epistaxis or hematemesis due to heat injury, heat decreases with blood loss, but vital Qi also diminishes. For severe Qi deficiency, double the dose of Ginseng as the sovereign herb. For Blood heat, double the dose of Raw Rehmannia as the sovereign herb. Frequent decoction and administration will stop the bleeding.
Lung-Draining Pill (Xiefei Wan)

8. For bloody cough with phlegm obstruction and rebellious Qi in patients with deficient constitution, use Perilla Seed Descending Qi Decoction to descend Qi. For accumulated heat, yellow phlegm, and robust constitution, use Lung-Draining Pill to purge. Lung-Draining Pill contains Trichosanthes Seed, Pinellia, Zhejiang Fritillaria, Curcuma, Semen Lepidii et Descurainiae, Apricot Kernel, and the Three Yellows (added only for excess patterns).
【Note】For bloody cough with phlegm obstruction and rebellious Qi in patients with deficient form and Qi, use Perilla Seed Descending Qi Decoction to descend Qi. The formula is found in the Asthma chapter. For yellow phlegm with accumulated heat and robust form and Qi, use Lung-Draining Pill to purge, which consists of Trichosanthes Seed, Pinellia, Zhejiang Fritillaria, Curcuma, Semen Lepidii et Descurainiae, Apricot Kernel, Coptis, Scutellaria, and Rhubarb. Rhubarb is added only when appropriate for robust form and Qi; if form and Qi are deficient, or if there is loose stool, it should be omitted.
Lung-Protecting Decoction (Baofei Tang)

9. Lung-Protecting Decoction is used for lung abscess with expectoration of pus and blood. It contains Bletilla, Coix Seed, Fritillaria, Honeysuckle, Tangerine Peel, Platycodon, Semen Lepidii et Descurainiae, and licorice nodes. Add Saposhnikovia at the onset; add Astragalus and Ginseng after ulceration.
【Note】Lung-Protecting Decoction consists of Bletilla, Coix Seed, Fritillaria, Honeysuckle, Tangerine Peel, Platycodon, Semen Lepidii et Descurainiae, and licorice nodes. Add Saposhnikovia at the onset; add Raw Astragalus and Ginseng after ulceration.
Cyathula and Four Substances Decoction (Niuxi Siwu Tang)

10. Hematuria with pain is called strangury blood (Lin Xue); hematuria without pain is called urine blood (Niao Xue). Urine blood is a disease of the essence orifice, treated with Four Substances Decoction doubled with Cyathula. Strangury blood is a disease of the urinary orifice, treated with Ba Zheng San plus Akebia, Rehmannia, and Curcuma.
【Note】Strangury blood and urine blood: if urine and blood exit together with pain, it is named strangury blood. If urine and blood exit separately, it is named urine blood. Urine blood is a disease of the essence orifice, treated with Four Substances Decoction doubled with Cyathula. Strangury blood is a disease of the urinary orifice, treated with Ba Zheng San plus Akebia, Rehmannia, and Curcuma.
Amber and Pearl Powder (Po Zhu San)

11. For urine blood unresponsive to various medications, where blood forms clots, orifices are obstructed, and the penis is painfully tight, use Amber and Pearl Powder mixed with Six-to-One Powder and Cinnabar, decocted with whole Akebia stem as a guide.
【Note】Urine blood is a disease of the essence orifice, often caused by retaining semen, sexual practices involving Qi control, or excessive desire in the elderly. For cases unresponsive to other medications, where urine blood forms clots, orifices are obstructed, and the penis suffers agonizing pain, use Amber and Pearl Powder, taken three times daily, each dose being three qian, guided by a decoction of whole Akebia stem (peeled yellow part). The formula is: Amber powder 1 qian, Pearl powder 0.5 qian, Cinnabar powder 0.5 qian, Calcined Talcum 6 qian, Licorice powder 1 qian, mixed evenly and divided into three doses. If constipation exists, purge with Ba Zheng San plus Cyathula and Curcuma. For heat and dysuria, clear with Chi Zi Tang plus Cyathula and Curcuma. Taking this medicine after dysentery yields miraculous results.
Sophora Flower Powder (Huai Hua San)

12. Hematochezia is caused by internal heat damaging the Yin collaterals. Wind combining with intestinal damp-heat forms intestinal wind (Chang Feng), characterized by clear blood; heat combining with dampness forms visceral toxin (Zang Du), characterized by turbid blood. Both are suitable for Sophora Flower Powder, consisting of fried Sophora Flower, fried Biota Leaf, vinegar-fried Aurantium, Coptis, and fried Schizonepeta Spike. Add Gastrodia and Saposhnikovia for wind; add Melia and Atractylodes for dampness.
【Note】The two types of hematochezia are intestinal wind and visceral toxin. Their root is heat damaging the Yin collaterals. Heat combining with wind forms intestinal wind, with clear blood; heat combining with dampness forms visceral toxin, with turbid blood. Both are suitable for Sophora Flower Powder, consisting of fried Sophora Flower, fried Biota Leaf, vinegar-fried Aurantium, Coptis, and fried Schizonepeta Spike, powdered and taken with sour plum decoction. For intestinal wind, add Gastrodia and Saposhnikovia. For visceral toxin, add fried Melia and fried Atractylodes. If there is severe swelling and pain with constipation, treat as an un-ulcerated visceral toxin abscess, not as simple visceral toxin hematochezia.
Yang-Raising, Dampness-Removing and Blood-Harmonizing Decoction (Shengyang Qushi Hexue Tang)

13. For chronic hematochezia unresponsive to cooling medicines, use ascending and tonifying methods with Yang-Raising, Dampness-Removing and Blood-Harmonizing Decoction. It contains Ephedra Stem (actually Shengma/Cimicifuga in context, though text says Shengma), Astragalus, Atractylodes, Cinnamon Bark, Gastrodia, Angelica, White Peony, Moutan Cortex, Tangerine Peel, Rehmannia (raw and cooked), and licorice (raw and honey-fried). Add Evodia and Coptis for heat; add Ginseng for deficiency.
【Note】For chronic hematochezia unresponsive to cooling medicines, ascending and tonifying treatment is suitable, using Yang-Raising, Dampness-Removing and Blood-Harmonizing Decoction. It consists of Cimicifuga, Astragalus, Atractylodes, Cinnamon Bark, Gastrodia, Angelica, White Peony, Moutan Cortex, Tangerine Peel, Raw Rehmannia, Cooked Rehmannia, Raw Licorice, and Honey-fried Licorice. For heat, slightly add Evodia and fried Coptis. For deficiency, add Ginseng.