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Wang Yanshi's Discussion:
There are cases where individuals, affected by summerheat and injured in their qi, suddenly vomit blood filling a bowl; there are cases where laborers, injured by overexertion, vomit blood at the change of solar terms; there are cases where anger injures the Liver, causing blood to rush out from the mouth, leading to temporary fainting and near-death states; there are cases where the Spleen fails to control blood, causing blood to deviate from its vessels, overflow into the Stomach, and be vomited out; there are cases where wind-cold invasion causes violent coughing that ruptures collaterals, resulting in blood being spat out from the Lungs. All these are treatable conditions. Only those caused by excessive sexual activity and excessive mental worry injuring the Shen (Spirit), leading to the hemorrhage of Heart and Kidney blood, are rarely curable (one in ten survives). For other types of bleeding disorders, one must examine the etiology and symptoms to apply treatment methods, whether clearing heat, warming, tonifying, purging, attacking, dispersing, harmonizing, or unblocking, without adhering rigidly to preconceived notions, but treating according to the disease itself, to regulate Ying and Wei (Nutritive and Defensive Qi), harmonize the Sanjiao (Triple Burner), so that Qi can anchor Blood and guide Blood back to its vessels. This is the method of guiding blood back to its normal course.

Bing's Commentary: This theory has a good foundation and contains no logical flaws. However, it overlooks that if blood stasis remains and does not re-emerge, it will inevitably flow into the Lung organ, causing coughing that transforms into consumption (Lao disease). The author was unaware of this. Therefore, after hematemesis, if coughing appears, medical treatment becomes very difficult.

Contemporary practitioners treating blood disorders, regardless of the cause, all attribute it to "excessive fire and rampant blood," immediately using cold and cool herbs to suppress the fire directly. Although this may temporarily stop the bleeding, the blood does not return to its vessels, often transforming into incurable consumption syndromes. They do not understand that when blood returns to its vessels, it circulates normally without vomiting; when blood does not return to its vessels, even if forcibly suppressed, it will inevitably vomit again after accumulation. It is like managing water: if one does not follow the nature of water to allow it to flow freely, but instead goes against its nature to prevent flow in an attempt to stop it, how can one avoid catastrophic bursting and widespread flooding? Thus, cold and cool medicines, when used appropriately, have rapid effects; when used inappropriately, they cause deep harm. Blood disorders are just one aspect of this.

Practitioners treating throat disorders dare not use warm medicines, similar to the approach for blood disorders. Do they not understand the etiology of throat disorders? Ten percent are due to wind-heat, and three percent are due to constrained fire. If the sore throat is indeed due to constrained fire, it is appropriate to use cold and cool herbs to suppress the fire; if accompanied by wind, wind should be dispersed simultaneously. Since the saying "white membrane throat contraindicates exterior-releasing methods" became popular, even wind-dispersing herbs are avoided. Due to the perceived harm of fermented soybean (Douchi), people misunderstood that bougainvillea seed (Niubangzi) should also not be taken. Consequently, upon seeing any sore throat, regardless of whether it is wind or cold, they indiscriminately prescribe extremely cold and cool herbs such as rhinoceros horn (Xijiao), antelope horn (Lingyangjiao), pearl (Zhenzhu), Coptis chinensis (Huanglian), Fly agaric mushroom (Mabo), Belamcanda root (Shegan), Isatis root (Banlangen), and Indigo naturalis (Daqingye), creating a rigid, stereotypical pattern. Those claiming expertise in throat diseases are all alike. Some even falsely diagnose white membrane throat to frighten patients. Who knows that white membrane throat is caused by coal toxicity? In the North, where coal is exclusively burned, this disease occurs; it is rare in the South. There are now cases where the throat makes sudden noises, sounding like snoring, with a white tongue that is not swollen, leading to death within moments. People do not know what disease this is; various medical texts call it "Lung Exhaustion." Recent authors call it "Lung Closure." In reality, it is cold in the Kidney meridian, a Yin syndrome throat obstruction, caused by the mistaken use of cold and cool medicines leading to death. If Guizhi Jiangtang (Cinnamon Twig and Ginger Decoction) were administered, immediate recovery would occur. Guizhi Jiangtang specifically treats sudden onset cases with no prior symptoms, which are deficiency-cold Yin-fire syndromes, not excess fire. The treatment method uses 5 fen each of Cinnamon Bark (Rougui), Prepared Ginger (Paojiang), and Honey-fried Licorice Root (Zhigancao), ground into fine powder together, placed in a bowl, poured with boiling water, kept in boiling water, shaken slightly, and swallowed slowly for immediate cure. Alternatively, take fresh Aconite root (Chuanfuzi) slices, coat with white honey (named Sanyin Mifuzi), roast thoroughly until black, store for use. When needed, take a grain-sized piece, hold in the mouth, swallow saliva, and recover instantly. Another prescription: regardless of season, use Sini Tang (Aconite, Dried Ginger, Honey-fried Licorice) or Jiangfu Lizhong Tang (Atractylodes macrocephala, Ginseng, Honey-fried Licorice, added with Ginger and Aconite), and self-healing will occur. Strictly avoid exterior-releasing, heat-clearing descending, and cold-purgative formulas. If it is not a cold syndrome, the mistaken use of Ginger, Cinnamon, and Aconite is incurable; thus, differentiation of symptoms is particularly important. The treatments for Jianggui Tang and Honey-coated Aconite slices are found in *Waike Quansheng Ji* (Complete Collection of External Medicine); the treatments for Sini Tang etc. are found in *Liangfang Jiyao* (Collection of Excellent Prescriptions). Because this syndrome is easily misdiagnosed, it is specially highlighted here.

Bing's Commentary: Throat disorders are mostly caused by wind-heat, complicated by phlegm-dampness, warm pathogens, mold toxins, etc., varying greatly. Common cases with exterior pathogen cough, fever, wiry-rapid pulse, and headache are treated by dispersing exterior pathogens while incorporating throat-clearing and detoxification methods, not merely using cold herbs. Therefore, predecessors always established principles for Lung-Stomach wind-heat syndromes by first dispersing then clearing. *Baihong Lun* (Treatise on White Membrane Throat) initially proposed five prescriptions by Zhang Xiuxiu of Liuyang. The exterior-dispersing formula uses Pueraria root (Gegen), Mulberry leaf (Sangye), Forsythia fruit (Lianqiao), Bougainvillea seed (Niubangzi), Processed Silkworm (Zhi Can), and Cicada slough (Chanyi). The heat-clearing formula uses Scutellaria root (Huangqin), Rehmannia root (Shengdi), Honeysuckle flower (Yinhua), Gentian root (Dancao), Fly agaric mushroom (Mabo), Olive (Qingguo), Smilax glabra rhizome (Tufuling), and Gypsum (Shigao), used only in 3-qian doses. Later, Ziwu Xiangshi, fearing exterior-releasing methods and exploring subtleties, forbade even Mulberry leaf and Mint, establishing Yangyin Bazhu Tang (Nourishing Yin Eight Pillars Decoction) with large doses of Rehmannia root, White Peony root, Ophiopogon tuber, and Scrophularia root, which are cold, cool, cloying, and stifling, suppressing wind-heat and harming patients. Regarding the mention of taking Sanyin Mifuzi, it is named Shaoyin Kidney Cold Damage; in acute cases, within one week, rescue is impossible. *Waike Quansheng Ji* and *Liangfang Jiyao* are simply cited books with narrow therapeutic lineages.