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Shengshengzi said: The Classics state, "Anger injures the Liver; in severe cases, it leads to hematemesis (vomiting blood) and飧泄 (diarrhea with undigested food)." It also states, "The Heart governs Blood, the Liver stores Blood, and the Spleen controls Blood." When anger causes Qi to rebel upwards, it damages the Spleen Qi. Consequently, the Blood stored by the Liver and controlled by the Spleen will flow recklessly and become disordered. In ancient prescriptions, Xiongfu Yin (Cnidium and Cyperus Decoction) was used with success. This is primarily because Chuanxiong Rhizoma (Chuanxiong) and Cyperi Rhizoma (Xiangfu) can regulate Liver Qi; when Liver Qi is harmonized, Blood returns to its vessels. Zhu Danxi once prescribed Cinnamomi Ramulus (Guizhi) five qian as powder, mixed with cold water for administration. This is because Guizhi can harmonize Ying and Wei (Nutritive and Defensive Qi), unblock blood vessels, and according to the theory that "Wood withers when encountering Cinnamon," along with being a method of "concordant treatment" (treating by following the nature of the pathogen), it shows that one should not rely solely on cold-cooling herbs for treatment. One must consider the pulse and symptoms together. If the pulse is weak, thready, and soft, and the spirit is exhausted, Dushen Tang (Single Ginseng Decoction) should be administered immediately. If the pulse is surging, wiry, long, and forceful, and the spirit is not fatigued, or if there is a sensation of Qi obstruction in the chest, or if the vomited blood consists of dark purple clots, Chengqi Tang (Gut-Draining Decoction) should be used to purge, which is the method of "removing firewood from under the cauldron" (treating the root cause). If the condition is mild and the blood color is bright red, Ge Keljiu's Shihui San (Ten Charred Powders Powder), Ejiao (Donkey-Hide Gelatin), or Xueyu Tan (Charred Human Hair) should be used to stop bleeding. Whether regulating Qi, purging, or stopping bleeding depends entirely on flexible clinical judgment; do not adhere rigidly to one method and harm life.

Hua Borun said: Regarding conditions such as blood extravasation, bloody discharge, and various signs of reckless bleeding due to accumulation, my usual treatment is to first use formulas containing Tao Ren (Persicae Semen) and Dahuang (Rhei Radix et Rhizoma) to move blood and break up stasis, thereby subduing the acute severity, before distinguishing and treating specifically. Someone asked: After loss of blood, how can the deficiency tolerate blood-moving and stasis-breaking agents? I replied: Since the blood is flowing recklessly and has lost its proper course, if we do not remove the accumulated stasis and promote circulation, the reckless flow will become the norm. How else can we control it? Moreover, what leaves will leave, and what generates will generate; where is the deficiency? Consider menstruation in women; some last for five or six days without stopping, others for ten-plus days. This shows that what goes goes, and what is generated is generated; this applies similarly to lactating women.

Shengshengzi said: Contemporary physicians treating bleeding disorders love using cold-cooling herbs and are often afraid to use warming and tonifying methods. This is also a biased view. If there is cold, it should be warmed; if there is deficiency, it should be tonified. Even sages cannot discard these principles, but one must understand them accurately and not act lightly. Suppose there is Stomach cold, or prolonged irritation by cold-cooling herbs leading to blood failing to return to its vessels; can warming be omitted? In cases of sudden massive hematemesis or epistaxis accompanied by fainting and flaccidity, can tonification be omitted? Therefore, Wang Haicang treated hematemesis caused by drinking cold damaging the Spleen using Lizhong Tang (Regulate the Middle Decoction) to regulate the Zhongwan area and separate Yin and Yang. This is also a method for treating internal bleeding. The *San Yin Fang* states: Lizhong Tang can stop hematemesis caused by Stomach injury because its function best regulates the middle Jiao, separates Yin and Yang, and stabilizes the blood vessels. Ge Keljiu treated hematemesis with fainting using Dushen Tang. Zhang Zhongjing stated: "When blood is depleted, benefit Qi." Li Dongyuan stated: "When Yang grows, Yin grows." All these have profound meaning; the practical application lies in using them when appropriate. However, if there is Yin deficiency with Fire hyperactivity, chronic cough, latent Fire in the Lungs, phlegm with blood streaks, or purple blood flakes, one should instead nourish Yin and moisten the Lungs, resolve stagnation, and clear phlegm. The previous warming/tonifying formulas dare not be tried lightly. Thus, it is known that for hemoptysis, expectoration of blood, or phlegm with blood streaks, nourishing Yin and moistening the Lungs should be prioritized. For sudden massive vomiting of blood with fainting, tonifying deficiency and warming the Spleen is most suitable. It all depends on investigating the source of the disease to avoid bias; this makes a good physician.

Hua Borun said: Various bleeding disorders are not all cold syndromes; they are generally considered to be forced by Heat in the Blood, causing reckless flow. Heat often coexists with other pathogens, such as Wind, Dampness, or Qi. There are also cases triggered by improper medication. Although the root causes may be similar, treatments for the Upper, Middle, and Lower Jiao differ. For the Upper Jiao, use Gardeniae Fructus (Zhizi), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Paeoniae Radix Alba (Baishao), Rhinocerotis Cornu (Xijiao - note: now substituted with Buffalo Horn), and Polygoni Multiflori Caulis (Puhuang), supplemented by Rehmanniae Radix (Disheng) and Moutan Cortex (Mudanpi). For Stomach bleeding, ancients used Weifeng Tang (Stomach Wind Decoction), which addresses Yangming Fire pathogen fanned by Wind, causing blood disturbance. The formula contains Cinnamomi Ramulus (Guizhi) to subdue Wood (Liver). For other cases, use Atractylodis Rhizoma (Cangzhu), Sanguisorbae Radix (Diyu), and Paeoniae Radix Alba, supplemented by heat-clearing agents. For Large Intestine bleeding, it is due to Hand-Yangming Fire pathogen combined with Wind and Dampness. Treatment uses heat-clearing and wind-dispelling agents, as Wind can overcome Dampness. Examples include Coptidis Rhizoma, Scutellariae Radix, Paeoniae Radix Alba, Phellodendri Cortex (Huangbai), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), and Notopterygii Rhizoma et Radix (Qianghuo). Adding Celosiae Cristatae Flos (Jiguanhua) follows the principle of "describing the category" (using herbs related to the symptom/form).

He also said: Bleeding triggered by fright belongs to the Heart; bleeding triggered by anger belongs to the Liver; bleeding triggered by worry belongs to the Lung; bleeding triggered by overthinking belongs to the Spleen; bleeding triggered by fatigue belongs to the Kidney.