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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Qi of the Taiyang (Greater Yang) channel reverses, it leads to stiffness and falling, vomiting of blood, and a tendency towards epistaxis (nosebleed). When the Qi of the Yangming (Yang Brightness) channel reverses, it results in panting, coughing, body heat, a tendency towards fright, epistaxis, and vomiting. Blood and Qi favor warmth and dislike cold. In cold, blood becomes stagnant and cannot flow; in warmth, it dissipates and flows normally. Loss of blood and loss of Qi are different names but share the same essence. Ying (Nutritive) Qi and Wei (Defensive) Qi are transformed from Essence-Qi; Blood is transformed from Spirit-Qi. Therefore, for those who have suffered severe blood loss, sweating should not be induced again. (Those whose blood has been depleted should not have their sweat further depleted; those whose sweat has been depleted should not have their blood further depleted.) If Heat from the Spleen transfers to the Liver, it causes fright and epistaxis. A pulse that beats forcefully, accompanied by epistaxis and body heat, indicates a fatal prognosis. A pulse described as "suspended hook floating" (referring to a hollow pulse, *Kou Mai*, which feels empty on pressure with sides firm like a bent finger) is considered a normal variation in this context. Great anger causes the form and Qi to sever, leading to blood stagnating in the upper body ("Yu" means accumulation). Excessive grief causes the Pericardium Collateral to close off; when closed, Yang Qi moves internally, causing collapse from below the heart and frequent hematuria (blood in urine). If Heat from the Pericardium Collateral transfers to the Bladder, it leads to strangury (difficulty/painful urination) or hematuria.

The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: The Master said, if the Chi (Cun Cun position at the wrist, corresponding to the lower jiao/kidneys) pulse is floating, and there is yellowish discoloration around the eyes, the epistaxis has not stopped. If the yellowish discoloration disappears and the eyes become clear, one knows the epistaxis has now stopped.
The Chi pulse inspects the Kidney. Kidney deficiency allows Ministerial Fire to disturb Yin Blood, which rises via the Bladder channel, hence the floating pulse. The Essence of the Kidney nourishes the pupils; the Bladder channel descends to the center of the forehead. Blood that does not follow the regular channels in these two meridians causes the yellowish discoloration. When the yellow fades, the blood disperses normally, thus indicating the nosebleed has stopped. *Ming Lilun* (Theory of Clarity) states: Epistaxis caused by Cold Damage (*Shanghan*) is attributed to pathogenic factors in the Exterior; epistaxis from miscellaneous diseases is attributed to pathogenic factors in the Interior. Here, the Chi pulse is floating, without mention of the Cun pulse floating, indicating Kidney deficiency with rebellious Blood Qi, not an external pathogen.

If a patient's face lacks color, without aversion to cold or fever, and the pulse is deep and wiry, epistaxis may occur; if the pulse is floating and weak, disappearing upon heavy pressure, hematochezia (blood in stool) may occur. Those with irritability and thirst will certainly vomit blood. (Another version reads: the patient's face lacks blood color.) The face is the bloom of Blood; when Blood vessels are harmonious, the complexion is fresh. If there is aversion to cold and fever, it is due to injury to the Blood. Now, without aversion to cold and fever, it is due to Blood depletion. Floating pulses inspect Yang; deep pulses inspect Yin. If only deep and wiry pulses are seen, and light pressure finds none, this is absence of Yang. Absence of Yang indicates upward depletion of Blood. If only floating and weak pulses are seen, and heavy pressure finds none, this is absence of Yin. Absence of Yin indicates downward depletion of Blood. Regarding irritability, thirst, and vomiting blood: Fire Qi disturbs the Spirit causing irritability; Fire moving in the Diaphragm causes cough and rebellion; coughing forces Blood to surge upward. Then, why can the absence of floating in deep pulses and absence of deep in floating pulses easily indicate Blood depletion? Because the face lacks blood color and the pulse is wiry and weak.

In men, a pulse that is deficient, deep, and wiry, without aversion to cold or fever, shortness of breath, abdominal urgency, difficulty urinating, pale complexion, occasional blackouts with epistaxis, and lower abdominal fullness, is caused by overwork. A deficient, deep, wiry pulse indicates lack of Shen Qi upon pressure; without aversion to cold or fever, it is clearly not an external pathogen. Shortness of breath, abdominal urgency, lower abdominal fullness, difficulty urinating, and pale complexion are all signs of internal Qi injury. Thus, although there are occasional blackouts and epistaxis, it is indeed caused by laborious exertion.

Men with a pale/thin facial complexion primarily suffer from thirst and blood loss. Sudden panting and palpitations with a deficient pulse indicate interior deficiency.
The Heart governs Blood; Heart deficiency leads to a deficient pulse. The first clause, citing pale complexion, indicates Heart Blood failing to nourish the exterior. The second clause, citing panting, palpitations, and floating pulse, indicates Heart Qi failing to fill the interior. All result from dissipation of Heart Spirit, loss of Blood, and injury to Jin-Ye (Body Fluids).

For those vomiting blood and experiencing cough with rebellious Qi, if the pulse is rapid, there is heat, and they cannot lie down, the prognosis is death.
This is due to insufficiency of both Metal (Lung) and Water (Kidney). Insufficient Water allows Fire to shine alone, injuring Metal. It is Kidney Water that nourishes Yin Blood inside and out. When Kidney Water is deficient, it cannot remain quiet, and Blood is forced out by Fire. Once Blood exits, the Yang of the Five Zang organs loses its pairing. Unpaired Yang is rootless, wild Yang, rising without descending, scorching Lung Metal, causing cough and rebellious Qi. The Yin of Lung and Kidney is exhausted with no return. Rapid pulse and body heat indicate Yang dominance alone. Inability to lie down indicates Yin exhaustion. When Yin is exhausted, Yang cannot survive alone; hence, it is fatal.

For wine drinkers who cough,吐血 (vomiting blood) inevitably follows. This is caused by excessive drinking.
Wine is intensely hot and injures Stomach Qi. Stomach Qi fails to maintain control, chaos arises in the chest, and Blood of the Middle Jiao cannot distribute to the collaterals. Due to Heat shooting into the Lungs, cough and rebellious Qi occur, and Blood overflows with the Qi. This is what *Qianjin Fang* calls vomiting blood due to Stomach injury.

For continuous vomiting of blood, use Bo Ye Tang (Cypress Leaf Decoction).
Water turns to hard ice underground when cold, and surges on land when windy. Human vomiting of blood is caused by Wind and Fire. Cypress leaf (*Bai Ye*) inherits the Qi of Metal in the West, restraining the rebellion of Liver Wood, so Blood has a place to store. Mugwort leaf (*Ai Ye*) is warm, allowing Fire to return to Yin and settle below. Using horse manure juice (*Ma Tong*) to descend rebellious Blood is very suitable. Family secret recipes often add three qian of Donkey-hide Gelatin (*Ejiao*). Li Shizhen's *Bencao Gangmu* records Ejiao but not Ai Ye; generally, the acrid-warm nature is taken to harmonize the bitter-cold nature. It treats not only continuous vomiting of blood but also lower bleeding.

If a patient has chest fullness, withered lips, blue-green tongue, dry mouth, desires only to rinse water in the mouth without swallowing, no aversion to cold or fever, and a pulse that is slightly large and slow, yet the abdomen is not full though the patient claims fullness, this is Blood stasis.
Any internal or external pathogen clashing with Blood, accumulating and not flowing, constitutes Blood stasis. Blood accumulation prevents distribution of Body Fluids, causing withered lips, blue-green tongue, and dry mouth. One desires to rinse water to moisten dryness. Blood is a Yin pathogen, and there is no internal heat, so one does not wish to swallow. Large pulse indicates Heat; slow pulse indicates Cold. Now, without cold/heat disease but with a slightly large pulse, it is Qi merging in the upper part, causing chest fullness. Slow pulse indicates Blood accumulation below the diaphragm. Accumulation in the tunnels of Yin meridians is not like Qi accumulation in the Huangmo (membranous tissue) of Yang meridians. Yang pathways are manifest; Yin pathways are hidden. Qi in Huangmo manifests as distension externally; Blood in tunnels causes only obstruction. Thus, the abdomen appears not full, but the patient feels full due to obstruction. Hence, we know it is caused by Blood stasis.

If a patient presents with symptoms resembling heat, irritability, fullness, dry mouth, and thirst, but the pulse surprisingly shows no heat signs, this is "Yin lurking"; it is Blood stasis. It should be treated with purgation.
Blood is Yin, paired with Yang. Qi harmonizes with Blood; Spirit rests in Blood; Throat is moistened by Blood; Meridians move with Blood. The body cannot be without Blood for a moment. Now, due to Blood stasis, Spirit lacks nourishment causing irritability; Qi lacks harmony causing fullness; Mouth lacks moisture causing dryness; Stomach lacks lubrication causing thirst. These are all cases where Yang loses its pairing, Ying and Wei do not distribute, and Body Fluids fail to transform, creating these symptoms. This is not comparable to Yang strengthening itself to generate heat; hence, it resembles heat. The pulse surprisingly shows no heat because Yin pathogens cannot stimulate the pulse, hence called "Yin lurking."

For bleeding from the anus where stool precedes blood, this is "distant blood." Use Huang Tu Tang (Yellow Earth Decoction). It can also treat vomiting blood and epistaxis.
The Classics state the Large Intestine and Small Intestine belong to the Stomach. It also says injury to Yin collaterals causes internal overflow of blood. Now, due to Cold pathogen in the Stomach injuring Yin collaterals, Clear Yang is lost, forcing Blood to overflow downward into the Two Yang channels (Large and Small Intestines), resulting in a condition of underlying Cold with superficial Heat. Therefore, we take the warming and Yang-assisting properties of Baizhu Fuzi Tang (Atractylodes and Aconite Decoction) to dispel Cold in Yin collaterals. We remove the acrid-dispersing Ginger and Jujube, adding Ejiao and Rehmannia to secure Yin Blood. Its brilliance lies in Scutellaria assisting Rehmannia to resolve superficial Heat in the Blood Chamber, while Kitchen Earth leads Aconite to directly warm the fundamental Cold of the Central Earth, avoiding rejection. However, it is suitable only if the blood color is dark and dull. If the blood is purple-red, thick, and glossy, using this formula will be dangerous. This is an error due to unclear differentiation, not a flaw in the prescription. *Qianjin Fang* uses Xuduan Zhixue Tang (Dipsacus Hemostatic Decoction), composed of Xuduan, Danggui, Guixin, Puhuang, Ejiao, Gancao, Ganjiang, and Shengdihuang. Listed here for reference based on syndrome.

For bleeding from the anus where blood precedes stool, this is "proximal blood." Use Chixiaodou Danggui San (Red Bean and Angelica Powder).
This formula appears in the Herpes Disease section, treating rapid pulse without heat, slight irritability, silence with desire to sleep, sweating. In the first 3-4 days, eyes are red like a turtledove's; after 7-8 days, the four corners of the eyes turn black. This is entirely damp-Heat injuring Blood, stagnating and transforming into pus. This sequence of blood then stool indicates Small Intestine Heat-Toxin flowing into the Large Intestine, a sign of Fire overcoming Metal. Thus, this formula is also indicated. Red Bean (*Chixiaodou*) clears Heat and promotes urination as the sovereign herb; sprouting it helps vent accumulated toxins, directing Bing-Ding (Fire) Qi down through the water pathways. Angelica (*Danggui*) acts as assistant, governing the authority of holding Blood, ensuring Blood returns to its course without scattering. *Qianjin Fang* uses Fulonggan Tang (Village Dragon Liver Decoction), which is Huang Tu Tang minus Baizhu and Fuzi, plus Ganjiang, Niuxi, Diyü, and Fahui. Compared to *Jingui*, there is a difference in Cold vs. Heat treatment; this must be distinguished. Thus, treating blood disorders, as long as Blood returns to its channels, distance need not be discussed.

For Heart Qi insufficiency causing vomiting blood and epistaxis, use Xiexin Tang (Drain the Epigastrium Decoction).
"Heart Qi insufficiency" refers to insufficiency of Yin-Jin (Yin Fluids), not insufficiency of Heart Fire. Therefore, Dahuang guides accumulated Fire; Huangqin and Huanglian drain Heat in the Heart; Blood naturally settles.
Zhao Yangkui said: Vomiting blood originating from the Kidney meridian is always Lower Cold and Upper Heat, a false syndrome of Yin excess below forcing Yang upward. Many people in the world do not recognize this and are misled. I alone perceive its subtleties and treat it as false cold. True Yin is lost, Mingmen Fire declines, Fire does not return to its source; Yin pathogens force floating Fire upward, causing cough, asthma, aversion to heat, red face, vomiting of phlegm-saliva and blood.
This is a false Yang syndrome. One must use Bawei Wan (Eight-Ingredient Pill) to guide Fire back to its source, taking it cold with water. After swallowing, the cold nature dissipates, and the warm nature activates, eliminating vomiting and hiccups. This aligns with Zhang Zhongjing's addition of human urine and pig bile to Baitong Tang to overcome rejection. If cold medicines are used immediately, death occurs instantly. Be cautious!

People have constitutions biased toward Yin or Yang; this is innate Qi endowment. Taiyang-type individuals, even in winter, do not need cotton clothes, constantly drink water, have unlimited sexual desire, and bowel movements once every few days; they take Huangqin, Huanglian, Zhimu, Huangbai, Xiaoshishi, and Dahuang without surprise. Taiyin-type individuals, even in summer, never leave thick clothes; if food/drink is slightly cool, they feel abdominal pain and diarrhea; Renshen, Baizhu, Ganjiang, Rougui are constantly consumed. Upon sexual activity, they groan incessantly. These two types each embody a bias of Yin or Yang. Discussing medicine with them, they cling to their biased nature, mistaking the part for the whole. Current physicians, failing to learn from this bias, formulate non-hot/non-cold prescriptions, revered by the world as the "Kingly Way." They do not realize that illness is contracted through bias: contracting Cold makes one biased toward Cold; contracting Heat makes one biased toward Heat. Using non-hot/non-cold agents cannot correct bias or save the defect. Thus, using Cold to treat Heat, and Heat to treat Cold, is the standard for physicians. However, why does frequent use of bitter-cold increase accumulated Heat, and year-long use of acrid-warm deepen sinking Cold? This is ignorance of Yin-Yang affiliation. In treating blood disorders, regulation before and after must target the Heart, Spleen, and Liver meridians. Heart governs Blood; Spleen envelopes Blood; Liver stores Blood. Guipi Tang (Restore the Spleen Decoction) contains herbs for all three meridians. Yuanzhi and Suanzaoren tonify Liver to generate Heart Fire; Fushen tonifies Heart to generate Spleen Earth; Renshen, Fuling, Gancao tonify Spleen to secure Lung Qi. Muxiang, whose fragrance enters the Spleen first, aims to return Blood to the Spleen, hence "Guipi." It is especially suitable for Liver injury from frustration and Spleen injury from overthinking. For excess Fire, add Zhizi and Danpi; for deficient Fire, add Rougui and Danpi. Bawei Tonics also cultivate the root of Pre-Heaven, leaving no method unused for blood disorders. For initial blood overflow or hemorrhage, use blood-moving and stasis-breaking agents to curb Qi depletion, then differentiate treatment. Question: If blood loss is followed by purgation, how can deficiency tolerate it? Answer: Since Blood wanders and loses its path, removing accumulation and promoting stasis drainage prevents wandering from becoming normal; how else to control it? What goes goes; what comes comes; where is the deficiency? Blood-loss patients require purgatives to break stasis when applied to the initial stage of accumulation/wandering; blood-depleted deficiency patients must not be purged, as a warning after loss.

Question: Human Yang Qi guides Yin Blood; Yin Blood anchors Yang Qi. Why do Clear and Turbid interfere, disrupting inside and outside, causing Blood to leave its channels, leading to upper overflow and lower leakage? Blood may come from vomiting, spitting, nose, eyes, ears, teeth, tongue, saliva, skin, or bowels/bladder. Some accumulate without flowing, causing varied harms. Please reveal the principles, categorizing Zang-Fu and Meridian sources to enlighten students. Shiwan answered: The Classics state Blood and Qi are different names, same essence. Though divided into Yin/Yang and Clear/Turbid, all derive from Grain-Essence. Initially mixed, undifferentiated. Driven by Spleen Qi, like mist steaming to Lungs to become Qi. If Qi is not consumed, it returns to Kidneys as Essence. If Essence is not leaked, it returns to Liver to transform into Clear Blood. If Blood is not drained, it returns to Heart, transformed by Li Fire (Heart Fire) into True Blood, nourishing Spleen, governing movement, sustaining life—nothing is more precious. Although Classics say Qi ascends to Lungs to become Blood, it essentially follows Five Element transformations, circulating like a ring. The above discusses general Ying/Qi/Blood principles. Ying/Wei are Essence-Qi; Blood is Spirit-Qi. Qi warms; Blood moistens. Though Qi is Yang-Harmonious and Blood is Yin-Substantial, Yin contains Yang, Yang contains Yin; they cannot be strictly separated. The purest, obeying the Monarch's command, harmonizes Five Zang, storing without loss, is Nourishing Blood. The turbid within clear, wielding transport power, sprinkles Six Fu, filling without overflowing, is Infusing Blood. The clear within clear, following Ying circulation, flows through hundred vessels, filling without leaking, is Ying-Meridian Blood. Source is one, split into three, each with jurisdiction. If each guards its territory, Yin and Yang are balanced; how could upper overflow/lower leakage occur? Generally, due to innate bias and labor injury, Blood leaks from weak/injured spots. Innate bias causes Grain-Essence to follow biased transformation; winner wins more, loser loses more. Yang excess leads to Yin decline; Yin decline leads to Fire prosperity; Fire prosperity drives Blood upward overflow. Yin excess leads to Yang weakness; Yang weakness leads to Fire decline; Fire decline loses control, causing Blood downward leakage. Upper overflow is not solely due to Fire excess; lower leakage is not solely due to Yang decline. Fresh-purple-thick blood indicates Fire excess; dark-pale-dull blood indicates Yang decline. Investigating the source: either Zang Qi rebellion or Fu Qi disorder causes disease. Upward overflow passes through Lung/Stomach; downward leakage passes through Intestines/Bladder. From Lung: due to Dragon/Thunder rebellion or cough/rebellion, blood overflows upward, often with phlegm foam or pinkish color. From Pericardium: overflows upward, bright red like lacquer. If vomited blood coagulates and doesn't stick to fingers, it is Stored Blood; seeing this means death. From Spleen: overflows from Stomach or leaks from Small Intestine, fresh-purple-thick, but less glossy than Pericardium blood. From Liver: vomits upward or leaks downward, dark-purple-thick, with threads or clots. From Kidney: coughs/spits, mixed in thin sputum like pearls, little blood, dull color, most severe. Rarely from essence aperture; if Qi transformation injured, from Bladder urethra. All relate to Zang Qi. From Stomach: mixed with fluids/phlegm, forms pools; abundant Qi/Blood, easy for medicine to reach, but less solid than stored blood. Yet, as root of Five Zang,不可忽视. Various epistaxis have sources, not just nose. Nasal epistaxis is Fire attacking Lung Metal; some are Yin excess forcing deficient Yang to leak. Though Classics distinguish Zang/Fu epistaxis, all relate to Hand-Taiyin (Lung) channel. Treatment distinguishes Yin/Yang, smooth/rebellious methods. Syndromes distinguish chronic/sudden epistaxis, tonifying/draining approaches. Dental epistaxis distinguishes Yangming/Shaoyin/Wind-Heat. From gum plate is Gingival Fistula (Yangming); loose teeth is Bone Disease (Shaoymin); swollen gums is Shaoyang Wind-Heat. Ear epistaxis distinguishes Liver/Kidney. Frequent, small amount, no swelling/pain is Shaoymin deficiency; sudden, painful, swollen is Jueyin Fire. Eye epistaxis is Jueyin; sudden blindness is Excess Fire; constant tearing/blood is chronic Wind-Heat. All apertures bleeding simultaneously: due to trauma or drug toxicity. If Liver/Kidney exhausted, Five Zang internal collapse, usually fatal. Tongue epistaxis: Hand-Jueyin Pericardium Fire excess. Tip ulcers is Deficient Fire; full-mouth large pulse carries Dragon/Thunder momentum insulting Monarch. Saliva blood is Spittle Epistaxis (Taiyin Qi uncontrolled). Skin pore blood is Muscle Epistaxis (Yangming Qi insecure). Above epistaxis: due to Ying Qi rebellion/fullness, Wei Qi laxity, failing to guard clear paths, unrelated to Zang Qi. Downward blood from Anus: distant/near based on stool timing. Near is Large Intestine; far is Small Intestine. Splashing vs. dripping distinguishes Wind/Damp. Splashing is Wind invasion; dripping is Damp adherence. Fresh/dark distinguishes Yin/Yang. Fresh is Yang excess; dark is Yang decline. Same as intestinal bleeding, hemorrhoids, female menstruation/postpartum blood. Though from intestines, relates to meridians, descending along channels differently. Metrorrhagia/menorrhagia downward leakage, retrograde menstruation upward overflow: though paths differ, all involve Chong Mai disease. Metrorrhagia is Spleen Qi sinking; retrograde menstruation is Liver Blood rebelling. Spleen is fluid bridge; Chong is Sea of Blood for Liver; all relate to Zang Qi. Liver/Spleen injury: blood not down, but sallow complexion, dark stool, indicates Blood stasis. Varied harms, hard to list. Internal injury jaundice, drum-distension, asthma/fullness, abdominal varices, postpartum敗血 (decayed blood) in meridians: all stasis diseases. Syndromes have deficiency-with-excess; treatments have tonifying-with-draining, flexible application depending on case. Generally, Blood/Qi favors warmth, dislikes cold; cold stagnates, warmth resolves. This is the secret of Xuanyuan (Yellow Emperor) and Qibo. But famous doctors today, seeing blood disorders, focus on cooling/Nourishing Yin. Initially effective, but recurring attacks deplete remaining Yang, causing vomiting, panting, loss of appetite, diarrhea. Still thinking medicine insufficient, they aggressively use bitter-cold. For those overflowing due to Yin failing to support Yang, this is hostile; for those leaking due to Yang failing to control Yin, it is poison. Yang drugs are violent; any mishap causes immediate harm. Yin-nature drugs are gentle; errors go unnoticed until death, avoiding criticism. Alas! Medical flaws are only told to confidants, hard to speak to the vulgar.