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In general, the treatment of hematemesis (vomiting blood) should prioritize descending Qi (vital energy), rather than clearing fire; promoting blood circulation, rather than stopping bleeding; tonifying the Liver, rather than attacking the Liver.

Why is it appropriate to descend Qi but not clear fire? When Qi is in excess, it transforms into Fire. Descending Qi leads to the descent of Fire; once Fire descends, Qi does not ascend abnormally. Blood follows the movement of Qi, thus avoiding the disaster of blood rushing upward and overflowing. Clearing Fire necessarily requires cold and cool herbs, which inadvertently damage Stomach Qi. If Stomach Qi is damaged, it loses its ability to control blood, causing blood to fail to return to the vessels even more severely. Currently, practitioners treating hematemesis have two major pitfalls. The first is the exclusive use of cold and cool herbs, such as Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Shanzhi (Gardeniae Fructus), Qingdai (Indigo Naturalis), and persimmon cake ash, or formulas like Siwu Tang (Four Substances Decoction) added with Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex). This often damages the Spleen, causing diarrhea, leading to untreatable conditions. The second is the exclusive use of Renshen (Ginseng Radix et Rhizoma), which causes Lung Heat, further injuring the Lung and worsening cough and rebellious Qi. There are cases where Renshen yields results; these are coughs caused by Qi deficiency. Since Qi belongs to Yang, this is not caused by Yin deficiency with blazing Fire. However, such cases account for less than one or two in a hundred. For these, it is appropriate to use Baishao (Paeoniae Radix Alba) and Zhi Gancao (Prepared Licorice Root) to subdue the Liver, Pipaye (Loquat Leaf), Maidong (Ophiopogonis Radix), Juhong (Tangerine Red Peel), Beimu (Fritillariae Bulbus), and Bohe (Menthae Haplocalycis Herba) to clear the Lung, Yiren (Coicis Semen) and Shanyao (Dioscoreae Rhizoma) to nourish the Spleen, Jiucui (Allii Tuberosi Rhizoma), Jiangxiang (Daemonorops Spica), and Suzi (Perillae Fructus) to direct Qi downward, Qinghao (Artemisiae Annuae Herba), Biejia (Testudinis Carapax et Plastrum), Yin Chaihu (Stellariae Radix), and Digupi (Lycii Cortex), Zaoren (Ziziphi Spinosae Semen), and Fushen (Poria cum Risus) to nourish the Heart, and Dihuang (Rehmanniae Radix), Shanzhuyu (Corni Fructus), Gouqi (Lycii Fructus), and Niuxi (Achyranthis Bidentatae Radix) to tonify the Kidney. This is a formula that has proven effective through repeated trials. However, there is no rapid method to tonify Yin; without prolonged administration, it will be ineffective. Patients desire quick results, doctors panic and lose their composure, trying various mixed medicines, leading to death. They repeat past mistakes without realizing them. How tragic!

Why is it appropriate to promote blood circulation but not stop bleeding? When blood does not follow the meridians, it is due to rebellious Qi obstructing upwards. Blood flows when heated and coagulates when cooled. Therefore, by descending Qi and promoting blood circulation, blood returns to the meridians, and bleeding stops naturally without the need for astringents. If one intentionally attempts to stop bleeding, blood coagulation occurs. Coagulated blood inevitably leads to fever, aversion to food, and pain in the chest and hypochondrium, causing the disease to become chronic and entrenched.

Why is it appropriate to tonify the Liver but not attack it? The Classics state: "The Five Zang organs store Essence and Qi and do not drain." The Liver is the official of the General, primarily responsible for storing blood. In hematemesis, the Liver fails in its duty. Nourishing the Liver calms Liver Qi, allowing blood to find its proper residence. Attacking the Liver causes Liver deficiency, impairing its ability to store blood, resulting in continued bleeding. These three principles are my unique insights, which I wish to share with the world.