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Any disease that is to be feared is none more than hemorrhage. If it is not stopped urgently, danger and death will follow immediately. However, why does hemostasis fail, or recur repeatedly after being stopped? This is largely because physicians of the time adhered to theories such as "fire carrying blood upward" and "erratic flow of blood vessels," without seeking the root causes in Yin and Yang, and indiscriminately administered cold and cool herbs. In cases of excess fire, occasional success might be achieved, but for critical patients with deficiency, deaths would follow one after another. Chu Qixian sighed that among those taking cold and cool herbs, fewer than one in a hundred survived; was this an exaggeration? I ponder that within the human body, there are internal Zang-Fu organs and external skin and muscles, while blood flows quietly within. How can it be allowed to disperse and escape? Only when the Lung is injured does blood appear mixed with phlegm; when the Spleen is injured, blood scatters into saliva and phlegm; when the Liver is injured, blood coagulates into dark purple; when the Kidney is injured, blood comes out with coughing and spitting; when both the Heart and Kidney are injured, blood gushes out violently, filling basins. Although there are differences in the quantity of Qi and Blood among these organs, there is absolutely no case where true Yin is sufficient yet blood moves recklessly, nor is there a case where Yuan Qi is abundant yet fails to contain blood.

I often see people with hemorrhage; unless there is severe damage to the Zang-Fu organs, blood loss is not easy to occur. Once it occurs, recovery from the condition is difficult, which can be discerned. It relies entirely on finding the root cause to treat it. One may tonify Yang to consolidate the Qi of the Spleen and Lung, such as in cases with a yellowish-white complexion and a deficient, large, empty, and soft pulse. Or one may tonify Yin to consolidate the Qi of the Kidney and Liver, such as in cases with a red face, dry mouth, and a deficient, thin, wiry, and rapid pulse. However, while the principle of tonifying Yang is well understood, within the method of tonifying Yin, there are cases of declining Fire. The symptoms include a bluish-white complexion and a slow, weak pulse, or a pulse that becomes bounding upon palpation after taking cold and cool herbs. All these should be treated by guiding fire back to its source (Dao Huo Gui Yuan), such as using Ba Wei Wan (Eight-Ingredient Pill) to dissipate yin shadows (yin-cold pathogens). Did you not see Li Chan (Lizai) treating Zhang Donggu? He vomited one or two mouthfuls of blood upon exertion. Li Chan used Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), adding Mai Men Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Shan Yao (Dioscoreae Rhizoma), Shu Di Huang (Rehmanniae Radix Praeparata), Fu Shen (Poria cum Radix), and Yuan Zhi (Polygalae Radix). Is this not tonifying the Spleen and Lung? Zhu Danxi often used Pao Jiang (Prepared Ginger) to stop bleeding. Miao Zhongren used Si Jun Zi Tang (Four Gentlemen Decoction) or Liu Jun Zi Tang (Six Gentlemen Decoction) plus Mu Xiang (Aucklandiae Radix), stating that ancient physicians often concluded treatment of blood disorders by regulating Stomach Qi. Is this not tonifying the Middle Jiao? Yang Kui stated that the Heart governs Blood, the Spleen envelops Blood, and the Liver stores Blood. Gui Pi Tang (Restore the Spleen Decoction) contains herbs for all three organs; using it rarely fails to produce miraculous effects. Is this not tonifying the Heart and Spleen?

I treated a friend, Wang Yigan, who vomited blood after excessive fatigue during the provincial examinations. The bleeding recurred despite repeated attempts to stop it. He had taken various Yin-tonifying herbs for over a year without effect. I observed his pale complexion, deficient, rapid, and powerless pulse, and noted that he did not feel heat intolerance. I said: "This is not only a deficiency of the Spleen and Lung, but also a decline of the Fire of the Gate of Vitality (Ming Men)." Therefore, I used Gui Pi Tang plus Pao Jiang (Prepared Ginger), Wu Wei Zi (Schisandrae Fructus), and doubled the amount of Ren Shen (Ginseng Radix). The bleeding subsided slightly. Occasionally, when I added Mai Men Dong (Ophiopogonis Radix), the condition reverted. Subsequently, I administered Ba Wei Wan (Eight-Ingredient Pill) continuously until the bleeding stopped. If the use of Ba Wei Wan was relaxed even slightly, the bleeding recurred. Later, he fathered two sons and resumed his examinations normally. Was this not tonifying the Ming Men? Thus, we know that substantial Blood depends on insubstantial Qi, and insubstantial Qi is nourished by the Fire of the Ming Men. As the saying goes: When Essence is sufficient, Qi is vigorous; when Qi is vigorous, Spirit arises. Spirit is the brilliance of Blood. Is this not true?

When observing ancient treatments for severe hemorrhage (Tuo Xue), they invariably used large doses of Du Shen Tang (Single Ginseng Decoction) to rescue the patient. Does this mean that if blood has not yet reached the stage of collapse, Ren Shen (Ginseng Radix) cannot be used? This is also something I do not understand. Therefore, in my treatment of hemorrhage, I must attend to the Spleen and Lung above, and nourish the Kidney Yuan below. I strictly prohibit the use of bitter-cold herbs to attack the body. Only then can I be worthy of the sages of old and prevent premature death.

Note: The above describes methods for treating the Five Zang organs. The Stomach is rich in both Qi and Blood. In sudden massive vomiting of blood, when the fire pathogen is blazing and intense, Si Sheng Wan (Four Generations Pill) must be used. Sheng Di Huang (Rehmanniae Radix) cools the Blood; He Ye (Nelumbinis Folium) and Bai Ye (Platycladi Cacumen) break up blood stasis; aided by the acrid-warm nature of Ai Ye (Artemisiae Argyi Folium), the blood will no longer stagnate but return to its vessels. For chest oppression due to Qi blockage and purple blood clots, this indicates blood depression in the upper jiao. Herbs such as Tao Ren (Persicae Semen), Zhi Ke (Aurantii Fructus), Chen Pi (Citri Reticulatae Pericarpium), and Xiang Fu (Cyperii Rhizoma) should be used to break stasis and descend rebellious Qi, thereby calming the Qi and stopping the bleeding. For hematuria, caused by Heart heat transferring to the Small Intestine, Qing Xin Lian Zi Yin (Clear the Heart and Lotus Seed Decoction) plus Bai Ye (Platycladi Cacumen), Niu Xi (Achyranthis Bidentatae Radix), and Xiao Ji (Cirsii Herba) is indicated. For hematochezia, caused by sinking of Yuan Qi, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Huai Hua (Sophorae Flos), Huai Jiao (Sophorae Immaturus Fructus), and Di Yu (Sanguisorbae Radix) is indicated. Treatment should be based on an assessment of deficiency and excess. As for epistaxis, where blood rushes through the clear passages, Si Sheng Wan (Four Generations Pill) is most excellent. In deficiency cases, Sheng Mai San (Generate the Pulse Powder) plus Huang Qi (Astragali Radix) and Bai Shao (Paeoniae Radix Alba) should be used to astringe. For gingival bleeding, Liu Wei Wan (Six-Ingredient Pill) plus Gu Sui Bu (Drynariae Rhizoma) is used. In deficiency-cold cases, Ba Wei Wan (Eight-Ingredient Pill) plus Gu Sui Bu (Drynariae Rhizoma) is used; Sheng Mai San (Generate the Pulse Powder) is also effective. How could this be bound by rigid rules?

Sheng Di Dan Pi Tang (Rehmannia and Moutan Decoction): Treats conditions with rapid pulse, internal heat, cough, and blood-streaked sputum.
Huai Sheng Di (Rehmanniae Radix), Mu Dan Pi (Moutan Cortex), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, decentered and ground), Mai Men Dong (Ophiopogonis Radix, decentered), Guang Chen Pi (Citri Reticulatae Pericarpium) (each 1 qian), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) (0.3 qian), Sha Shen (Glehniae Radix) (1 qian). (If bleeding does not stop, add E Jiao (Asini Corii Colla) 1 qian, stir-fried with Ge Fen (Calcitris) until pearl-like). Add 1 qian of baked Bian Bai Ye (Platycladi Cacumen). Decoct in water and take orally. For vomiting blood, remove Mai Men Dong (Ophiopogonis Radix) and add He Ye (Nelumbinis Folium) and Ai Ye (Artemisiae Argyi Folium), or add Ou Jie (Nelumbinis Node) and Tong Bian (Human Urine).

Dang Gui Zhi Xue Tang (Angelica Hemostatic Decoction): Treats conditions with wiry pulse, hypochondriac pain, and rebellious Qi.
Dang Gui (Angelicae Sinensis Radix) (1 qian), Xiang Fu (Cyperi Rhizoma) (1 qian, prepared with wine), Sheng Di (Rehmanniae Radix) (1 qian), Bai Shao (Paeoniae Radix Alba) (1 qian, stir-fried with wine), Mu Dan Pi (Moutan Cortex) (1 qian), Su Zi (Perillae Fructus) (1 qian), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) (0.3 qian), Guang Chen Pi (Citri Reticulatae Pericarpium) (1 qian). Add 1 qian of baked Bian Bai Ye (Platycladi Cacumen). Decoct in water and take orally.

Bai Ji Tang (Bletilla Decoction): Treats internal injury causing vomiting of blood.
Bai Ji (Bletillae Rhizoma), Qian Cao (Rubiae Radix et Rhizoma), Sheng Di (Rehmanniae Radix), Dan Pi (Moutan Cortex), Niu Xi (Achyranthis Bidentatae Radix), Guang Pi (Citri Reticulatae Pericarpium), Gui Wei (Angelicae Sinensis Radix Tail) (each 1 qian). Add five He Ye Di (Nelumbinis Petiole Nodes). Decoct in water and take orally.

Tonifying formulas are found in the preceding discussion.