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I once treated a man who suffered from hematemesis (vomiting blood) after eating to fullness and bending forward while carrying a heavy load. Various medicines were ineffective, but he recovered and did not relapse after taking Sisheng Wan (Four Raw Decoction Pills) and Qingbingzi (Green Cake).

In observing Chu Yushi's treatment of hematemesis, he disliked using Zhu Ru (Bamboo Shavings), Sheng Di Huang (Rehmanniae Radix Recens), and Ou Zhi (Lotus Root Juice). However, one should not rigidly adhere to this view. If Yang pathogen invades the Yin aspect, blood becomes heated and scatters, similar to water boiling over; in such cases, it is appropriate to administer cooling herbs to resolve the heat. Would Da Huang (Rhei Radix et Rhizoma), Xi Jiao (Rhino Horn), Sheng Di Huang, Sheng Ai Ye (Mugwort Leaf), and Ou Zhi be ineffective? Conversely, if Yin pathogen invades the Yang aspect, akin to freezing weather where water turns to ice, it is appropriate to administer warming herbs to warm the body. Would Gan Jiang (Zingiberis Rhizoma) and Rou Gui (Cinnamon Bark) be without efficacy? Students of medicine should ponder this deeply.

Sisheng Wan (Four Raw Decoction Pills): Treats hematemesis. For any case of hematemesis or epistaxis (nosebleed) caused by Yang pathogen invading Yin, leading to reckless bleeding due to blood heat, this formula is suitable.

Sheng He Ye (Fresh Lotus Leaf), Sheng Ai Ye (Fresh Mugwort Leaf), Sheng Bai Ye (Fresh Biota Top), Sheng Di Huang (Rehmanniae Radix Recens).

Take equal parts of the above, pound until soft and grind finely, form into pills the size of a chicken egg. Take one pill per dose. Decoct with three cups of water until reduced to one cup, remove dregs, and take warm at any time.

Chen Rihua stated: His father traveled to Lingshi Temple in Fuqing during the early Shaoxing era. The abbot hosted him for a meal. As the meal was concluding, an attendant went to the hall; upon returning after the vegetarian meal, he stood in attendance. Seeing that the table was unstable, he bent his waist severely to support it. Upon raising his head, he immediately vomited blood, as the full stomach combined with the twisting motion ruptured the lung tissue. The following year, when visiting the temple again, he asked if the person who had vomited blood the previous year was well. The abbot replied that he had recovered after taking Sisheng Wan. Since obtaining this formula, it has been used successfully to save many lives.

For severe heat causing hematemesis, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) or Xiao Sanhuang Wan (Minor Three Yellows Pills) from the *Jufang* (Official Formulary), taken with thick decoction of Bai Mao Gen (Imperatae Rhizoma). This method is excellent.

To treat internal blood stasis presenting with epistaxis, hematemesis, sallow complexion, and black stools:

Shao Yao (Paeoniae Radix Alba) (3 fen), Sheng Di Huang (Rehmanniae Radix Recens) (8 liang), Mu Dan Pi (Moutan Cortex) (remove heart, 1 liang), Xi Jiao Xie (Rhino Horn shavings) (1 liang; if unavailable, use Sheng Ma or Chuan Xiong as substitutes).

Cut the herbs into small pieces. Take 5 qian per dose, decoct with water and take orally. If there is fever accompanied by delirious behavior, add Huang Qin (Scutellariae Radix) 2 liang.

To treat hemoptysis (coughing up blood):

Qing Dai (Indigo Naturalis), Xing Ren (Prunus Semen) (each 1 liang. Hua Tuo's formula uses apricot kernels fried with Ouli Fen (Ostreae Concha powder), removing skin and tips; Ostreae Concha is not used).

Grind these together into a paste. Melt Huang La (Beeswax) and mix to form thirty cakes. Take one cake per dose. Sandwich it between half a dried persimmon, wrap in wet paper, and roast until fragrant. Chew together and swallow with congee drink, at any time.

If Yin pathogen invades Yang, causing cold in the Heart and Lung meridians leading to hematemesis, Gan Jiang Gan Cao Tang (Ginger and Licorice Decoction) is appropriate.