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Gu Meixian, in his early twenties. His body was obese. He had a habit of indulging in alcohol. Recently, after becoming widowed, he lived in depression. In the first month of summer (Mengxia) of the Renwu year, he suffered from a hemorrhagic disorder. Every night, he vomited blood equivalent to one or two bowls. By the third month of summer (Jixia), the amount of blood loss became immeasurable. His complexion did not appear haggard, nor did his muscles show emaciation. Palpation of his pulse revealed no surging and fullness. There were no alternating chills and fever throughout day and night. He only suffered from panting and shortness of breath, frequent coughing at night, a sensation of obstruction in the throat, tightness and pressure in the chest, stabbing distension in the back, dull pain in the abdomen, irritability, and anger. Physicians treated the hemorrhage according to established methods using Renshen (Ginseng Radix) and Ejiao (Donkey-hide Gelatin). After more than a month of use, the condition worsened. Several other physicians attempted various remedies: some used moistening pastes to descend Qi; others used Niuxi (Achyranthes Root) and Huangbai (Phellodendron Bark) to guide downward and stop bleeding. A small amount of Sanqi (Notoginseng Radix) processed with wine was administered, which temporarily stopped the bleeding and relieved the panting. However, shortly thereafter, bleeding recurred and coughing intensified. It was then attributed to "Dragon Fire" (hyperactive fire from deficiency), and it was intended to use small amounts of Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) from Bawei Wan (Eight-Ingredient Pill with Rehmannia) to lead fire back to its source. This was ultimately due to a failure to recognize the true nature of the disease. Let us elaborate on the pathogenesis based on this case.

Blood belongs to Yin. Men are naturally deficient in Yin, so they regard blood as precious. Therefore, in cases of hemorrhage, Yin deficiency often leads to fever, a withered and dark complexion, and muscle emaciation.
The present patient is different. Does he have an excess of blood? No. The cause lies in strong alcohol damaging the Stomach. The Stomach is the sea of water and grain, rich in Qi and Blood. The essence nourished by food and drink over twenty years has gradually been depleted internally, though this is not apparent externally. The Stomach meridian runs from the head to the feet, naturally descending. Due to vomiting blood, the Qi rebels and ascends, causing respiratory sounds to become rapid and panting. The Qi transmitted from the Stomach to the Large Intestine, Small Intestine, and Bladder also naturally descends. Due to repeated vomiting, the Qi rebels upward and fails to descend, causing pain and stifling distension in the intestines and abdomen.

When Stomach Qi rushes upward, rebelling violently, the Qi in the Chest becomes chaotic. The tightness and painful distress indicate severe chaos. Since the space in the Chest is limited, the chaotic Qi has nowhere to reside and inevitably attacks the Back, for the Back is the mansion of the Chest. The drilling pain like a blade stab in the shoulder blade area indicates deep invasion. Thus, the Stomach is divided into three parts: the Upper Jiao (Shangwan) has abundant Qi, the Lower Jiao (Xiawan) has abundant Blood, and the Middle Jiao (Zhongwan) has both. Now that the Stomach is chaotic, Qi and Blood are mixed. This extends beyond the Stomach. Above the Stomach is the Diaphragm. The mental restlessness and anger correspond to the *Neijing* statement: "Blood congregates above the Diaphragm, and Qi congregates below the Diaphragm," resulting in inverted Qi and Blood. The *Neijing* further states: "When Blood congregates in Yang and Qi in Yin, it becomes 'Heat Zhong'." It also says: "Disease caused by heat becomes 'Xiao Zhong'." Heat is 'Dan'. Xiao Zhong is characterized by excessive hunger and appetite but hidden muscle loss. The patient's drinking habit stems from heat accumulating in the Stomach. Why does he suffer from vomiting blood instead of Xiao Zhong? The *Neijing* states that if the Stomach pulse, which should be surging and full, appears deep and fine, it indicates rebellious Stomach Qi. If the Yingchu pulse is surging, heat gathers in the Stomach leading to internal abscesses. Given the current deep and fine pulse, why an abscess and not vomiting blood? The source of this patient's vomiting blood shares the same origin but presents differently. Heat accumulating internally manifests as Xiao (wasting-thirst); Blood accumulating internally manifests as Abscess. With accumulation followed immediately by vomiting, this specific syndrome arises. Investigating the cause, it must stem from sexual activity after heavy drinking and eating. Generally, when Qi moves, Blood moves. The Qi associated with Essence possesses the imagery of heaven and earth forging. When Blood moves excessively, since Essence is transformed from Blood, the infusion is not limited to the Stomach meridian alone. However, the Blood moved in this meridian is obstructed by the remnants of heavy drinking and eating, preventing it from continuing along the unceasing pathways with Blood from other meridians. Thus, a breach for massive blood loss opened. Now it has become a habitual route. To treat this, one must differentiate by meridian and syndrome; otherwise, where does one begin?

It is not only the meridians but also the collaterals that require differentiation. The great collateral of the Stomach pierces the Diaphragm and connects to the Lung. Without distinguishing the collaterals, who would know that the tight bursting in the Diaphragm and Qi distension with sticky phlegm in the Lung are transmissions from Stomach disease? During late summer, when Earth is prosperous, not only does the mother organ suffer, but the child organ loses nourishment, and moreover, the pathogen of the mother fully transmits to the child. By the third autumn, when Dry Metal governs, the afflictions of coughing, panting, and fullness will surely increase. If not treated urgently, it will be too late. This year, Shaoyin governs the Heaven, with Heat Qi presiding above Shaoyin. The movement of Qi is Heat. Summer coincides with hot weather, so the seasonal climate is Heat. Combined with the accumulated heat in the Stomach, they fan the tyranny together. Unless the heat is treated, the bleeding will not stop. However, stopping the bleeding is not difficult; the concern is its aggregation. Aggregation in the middle results in Gu (parasitic disease) or abscess, which is relatively slow. Aggregation in the upper region results in panting and syncope, which is sudden. One must primarily follow the *Neijing* principle: "For excessive heat causing blood overflow, treat with salty and cold substances." Salty substances enter the Blood, and cold substances overcome heat. This way, complications of wasting-thirst and carbuncles can be avoided. First, however, the meridian disease must be removed, ensuring the meridians descend and meridian Qi flows downward, before addressing the collateral disease. This is like clearing ditches so that floodwaters can subside. This is not easy to explain.

The patient had been vomiting blood for a long time with no method to stop it. His father and brothers earnestly invited me to treat him. I told them that one must discuss the disease before discussing the prescription. Only then could medication be used. I formulated this case plan: dissolve Xuanmingfen (Natrii Sulfas) in water to decoct Huangbai (Phellodendri Cortex), and dissolve Qiushi (Calx Gypsumis) in water to decoct Zhimu (Anemarrhenae Rhizoma), to clear concealed heat, resolve stasis, and transform abscesses. Add Gancao (Glycyrrhizae Radix et Rhizoma) to moderate the bitter taste. Exclusively utilizing salty and cold flavors, four doses were administered, and the bleeding stopped. This was miraculous. The physician indeed considered the medicinal properties too cold, and the family failed to complete the course. By August, the patient's chest and hypochondrium swelled several inches around, an abscess formed in the Lung, chills and high fever erupted severely, panting and coughing ceased not, food and drink were refused, lying prone on the desk without movement, causing flesh to wear through, critical and breathing heavily. Hundreds of desperate measures were taken to treat him, but he refused compliance. His father and brothers harbored resentment and again sought his help for the impossible, to satisfy human relations. I had to strive hard to treat him. Complications emerged like bees. Counting all outcomes, five deaths were avoided and five lives saved. The patient did not abstain, consuming raw and cold foods, causing another lung abscess. One night, he expectorated sputum resembling pig bile, over a hundred pieces. One organ injured twice, he eventually died. I labored anxiously for a hundred days, exhausting my mind and strength. Yet, what can be done when the end cannot be reversed?

Mr. Hu Youchen said: "Previously, it was reported that Gu's illness was cured, and people competed to call him a deity. Later, however, judgment was inevitably based on success or failure. If, when using salty and cold medicines, there had been knowledgeable individuals to endorse them, how could it have come to digging a well when thirsty and casting weapons when fighting? Nevertheless, this case is worthy of transmission."