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(Tufting blood, coughing up blood, spitting blood, epistaxis, gingival bleeding, various types of bleeding from orifices, hematochezia, hematuria, bloody strangury, metrorrhagia)
The *Neijing* (Inner Canon) states: The middle jiao receives qi from food and drink, extracts the essence and fluids, transforms them into red, which is called blood. The flow and overflow of blood: half travels along the Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) within the meridians, and half scatters outside the vessels to nourish muscles, interstices, and skin and hair. If affected by external pathogens or injured internally, blood fails to follow its normal pathways. Surging upward, it results in tufting blood, coughing up blood, spitting blood, epistaxis, gingival bleeding, and lingual bleeding; flowing downward, it results in hematochezia, hematuria, and metrorrhagia in women. The source is essentially the same. One may ask: Various texts treat bleeding based on differentiation among the Zang and Fu organs; why is this discussed generally? I say: The Zang organs contain blood, while the Fu organs do not. Observing dissected animals, the area around the heart below the chest and adjacent to the spine (Pericardium) contains much blood, the Liver interior contains much blood, and the Heart, Spleen, Lung, and Kidney each contain blood, whereas the Fu organs have no blood. Recently, people observe frequent tufting blood and claim it is stomach blood; this is a mistake derived from blindly accepting previous physicians' errors. Any case involving the expulsion of blood from the Zang organs is fatal. As for tufting blood, nasal bleeding, metrorrhagia, and lower bleeding, these are all blood from the scattered pathways of the meridians. One may ask: If there is no differentiation, why does the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) use Xiexin Tang (Heart-Draining Decoction) to treat tufting and nasal bleeding caused by insufficiency of Heart Qi? I say: All diseases are inseparable from the Zang and Fu organs. Disease of the Zang and Fu organs causes blood to fail to follow its normal pathways, resulting in tufting, nasal bleeding, metrorrhagia, and lower bleeding; it is not that the blood expelled in these conditions originates directly from the interior of the Zang organs. The character "Jing" (Meridian/Pathway) in "following the Jing" should be interpreted as "Chang" (Normal Path). Contemporary physicians misunderstood this, believing that Guipi Tang (Restore the Spleen Decoction) guides blood back to the Spleen, and since the Spleen controls blood, this constitutes "returning to the meridian," causing immense harm. Let me awaken you with one sentence: What follows follows its normal path of following; what moves moves along its normal path of movement; what scatters scatters along its normal path of scattering; what nourishes nourishes along its normal path of nourishment. If blood follows its normal pathways, there will be no diseases of tufting, nasal bleeding, metrorrhagia, or lower bleeding. For millennia, no one has mentioned this. At the point where Gao Shizong led without revealing fully, I carefully analyzed and reasoned, finding great pleasure.

Body heat and a large pulse indicate difficult treatment. ○ Cool body and quiet pulse indicate easy treatment. ○ If there is panting, coughing, urgency, and rebellious Qi ascending, with a string-taut, tight, fine, rapid, and forceful pulse, and inability to lie down, death is imminent.

For exogenous invasion causing tufting blood, presenting initially with headache, aversion to cold, fever, etc., healing requires mild sweating. Xiangsu Yin (Fragrant Perilla Drink) is suitable, added with Jingjie Sui (Schizonepeta Spike) 1 qian, Danpi (Moutan Cortex) and Baishao (White Peony Root) each 1.5 qian. (35)

For summer or autumn season exposure to summer-heat or dryness causing tufting blood, see the Cough section for formulas and treatment; no further elaboration.

The *Neijing* states: Not avoiding heat leads to the arrival of heat, generating diseases of blood overflow and blood leakage. Those who do not avoid summer heat and overconsume fried or roasted foods cause blood-heat to move recklessly. Sisheng Wan (Four Generations Pill) is suitable. (One day)

For vomiting due to Blood Stasis, chest pain must precede it; the blood color must be purple or black and clotted; the pulse must be choppy and stagnant. Siwu Tang (Four Substances Decoction) is suitable, added with Vinegar-fried Dahuang (Rhubarb Rhizome), Taoren (Peach Kernel), Danpi (Moutan Cortex), and Xiangfu (Cyperus Rhizome) each 1.5 qian. ○ Once the purple blood is exhausted and fresh red blood appears, immediately switch to Liujunzi Tang (Six Gentlemen Decoction), adding Danggui (Angelica Sinensis)... [Text implies continuation].

For Taiyang Cold Damage and Warm Diseases, where sweating should have been induced but was not, leading to internal heat accumulation, blood stasis, and epistaxis, or incomplete tufting blood, leaving residual blood stasis inside, with black stool and yellow complexion, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is suitable. (99)

Gao Gufeng excels particularly in the methods for treating blood disorders. He stated: Except for blood stasis and Cold Damage, the rest belong to causes such as Seven Emotions, hunger, satiety, and labor. These must present with nausea (symptoms are distinct and verifiable); Guyuan Tang (Single Herb Solidify Origin Decoction) is the primary treatment. The formula uses Renshen (Ginseng Root), Zhigancao (Honey-fried Licorice Root), Dangguishen (Danggui Body), Wei Jiang (Baked Ginger), Dazao (Jujube Fruit), and Baishao (White Peony Root), decocted in water. Blood disorders are most complex... [Text implies continuation].

Renzhai Zhizhi states: Yang deficiency leads to Yin escape. Beyond major tufting and major nasal bleeding, if there are signs of cold, Lizhong Tang (Regulate the Middle Decoction) can be used, added with Nanmuxiang (Tasmannia Stem) or Gancao Ganjiang Tang (Licorice and Ginger Decoction), yielding better effects. Also, dietary injury to the Stomach, where Stomach deficiency fails to transport and transform, causing Qi to rebel upward, can also lead to tufting and nasal bleeding; the aforementioned two formulas are also suitable. ○ I use Gancao Ganjiang Tang (Licorice and Ginger Decoction), with Ganjiang (Zingiber Rhizome) charred, added with Wuweizi (Schisandra Berry) 2 qian, which is very effective. This comes from Shen Rou's Five Books.

The *Neijing* states: Blood and Qi prefer warmth and dislike cold; cold causes stagnation and lack of flow, while warmth causes dissipation and removal. These few sentences are the key principle for treating blood disorders. Thus, the methods of Yang Renzhai and Gao Gufeng are miraculous. Zhang Jingyue uses Shudi (Prepared Rehmannia Root) 1 liang, Zexie (Alisma Rhizome), Fuzi (Aconite Lateral Root), Niuxi (Achyranthes Root) each 1.5 qian, Rougui (Cinnamon Bark) 1 qian, Zhigancao (Honey-fried Licorice Root) 2 qian, decocted in water, named Zhenyin Jian (Yin-Suppressing Decoction). Although the formula is mixed, it contains more warming herbs and can still achieve efficacy.

Chushi Yishu states: Although blood is a Yin category, what transports it is Yang Harmony? The term "Yang Harmony" refers to the Heart and Lung. The Yang of the Heart and Lung should be distributed; like the sun and moon rising, small fires lose their light. All kinds of evil heat Qi are eliminated, blood is undisturbed, and thus follows the normal pathways. The phrase "what transports it" is even more exquisite. Blood cannot transport itself; it must rely on Qi to transport it. Once transported, it follows the Chong Mai and Ren Mai within the meridians, scatters outside the vessels, and nourishes the skin and hair, having normal pathways to follow. How could it move recklessly and become a disorder of blood loss? All schools praise the excellence of these two sentences but fail to elucidate their meaning. The Way of Medicine is indeed difficult. Although Gao Gufeng did not fully comprehend this meaning, his Guyuan Tang coincides with it implicitly. Master Shen Rou focuses on preserving Yuan Qi, merely taking Huangqi (Astragalus Root) to tonify Qi to generate Blood, which also coincides with this meaning implicitly. Combined, they yield rapid effects; hence these two masters became famous at the time. I have gained something from my thousand reflections and dare not keep it secret.

Baoyuan Tang (7 Shen Rou's formula. No Rougui. Has 3 slices of Wei Jiang and 2 Heizao.)
Danggui Buxue Tang (6)

There are blood disorders unsuitable for rigid and drying agents. Or when Blood Deficiency causes irritability and thirst, low-grade fever, restless sleep and waking, and five-palm heat. Shengyu Tang (Sageness Enhancing Decoction) is suitable. (18)

For bleeding from the tongue like drilled holes, decoct Xiangru (Mosla Herb) juice and take orally. Externally, apply fried and powdered Huaihua (Sophora Flower) or Puhuang (Lygodium Spore). ○ For gingival bleeding, soak 4 liang of raw Zhuru (Bamboo Shavings) in vinegar overnight and gargle. ○ For interdental bleeding, dip a paper wick in a small amount of Gan Chan Su (Toad Venom) and press on the bleeding site to stop it immediately. ○ For bleeding from all teeth, powder Gouqizi (Lycium Fruit), decoct in water, and gargle. Then swallowing the root is also acceptable. ○ For epistaxis, decoct 1 liang of raw Maohua (Imperata Flower) or root and take orally. For the above symptoms, one may uniformly use Ganlu Yin (Sweet Dew Drink) (87) or Zishen Wan (Nourish Kidney Pill) (94).

For bloody strangury and hematuria, decoct 10 Zhu Gen (Ramie Root) in water and take. Alternatively, mix Haipiaoxiao (Cuttlefish Bone), Shengdi (Rehmannia Root), and Chi Fuling (Red Poria) in equal parts into powder; take 3 qian per dose, washed down with decoction of Baiye (Arborvitae Leaf) and Cheqianzi (Plantago Seed). Alternatively, burn disordered hair to ash, add a little Shexiang (Musk), and mix with rice vinegar and warm water to take. If pain is unbearable, mix with Ouzhi (Lotus Rhizome Juice), Luobozhi (Radish Juice), and Baimi (White Honey) to take. ○ For hematuria combined with sexual exhaustion, use Luzhujiao (Deer Antler Glue) 0.5 liang, Moyao (Myrrh) separately ground, and You Toufashe (Oily Hair Rope) each 3 qian into powder; make pills the size of paulownia seeds using Zhu Gen juice and flour paste; take 50 pills per dose, washed down with salt water.

For lower bleeding, bleeding after stool is distant blood. Use Zaot Zhong Huangtu (Yellow Earth from Hearth) 8 qian, Gancao (Licorice Root), Shengdi (Rehmannia Root), Baizhu (Atractylodes Rhizome), Shu Fuzi (Prepared Aconite Lateral Root), Ejiao (Donkey-hide Gelatin), Huangqin (Scutellaria Root) each 1.5 qian, decoct in water and take, named Huangtu Tang (Yellow Earth Decoction). ○ Lower bleeding, bleeding before stool is near blood. Use Chixiaodou (Adzuki Bean) 3 liang, soaked until sprouting and dried, plus Danggui (Angelica Sinensis) 1 liang, ground into powder; take 1.5 qian per dose three times daily with Jiangshui (Fermented Rice Water), named Chixiaodou Danggui San (Adzuki Bean and Angelica Powder). ○ Both formulas originate from *Jingui*.

For continuous lower gastrointestinal bleeding unresponsive to other medicines, Jisheng Wumei Wan (Wumei Pill from the Prescriptions for Saving Lives) is suitable. (69)

For cutaneous blood sweat, remove the peel of Yuliren (Bush Cherry Kernel), grind 2 qian, and take mixed with E Li Zhi (Pear Juice). Alternatively, bake Renzhongbai (Urine Deposit) until dry, add a little Shexiang (Musk), and take mixed with warm wine for immediate effect. Alternatively, use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction), added with Wuweizi (Schisandra Berry) 1 qian, Maidong (Ophiopogon Tuber), and Chuanxuduan (Dipsacus Root) each 2 qian.

For bleeding from all orifices, use equal parts of Toufa (Human Hair), Baizong (Decayed Palm Fiber), and Chen Lianpeng (Old Lotus Pod), all burned to ash and ground; take 3 qian per dose, washed down with Muxiang (Costus Root) tea.

For metrorrhagia in women, assess cold, heat, deficiency, and excess, and select from the above formulas accordingly. In the moment of massive blood loss, if unconscious and sweating profusely without stopping, Shenfu Tang (Ginseng and Aconite Decoction) is suitable. For the poor, Danggui Buxue Tang (Danggui Tonifies Blood Decoction) added with Shu Fuzi (Prepared Aconite Lateral Root) 2-3 qian is suitable. (105)

In the moments of major tufting, major epistaxis, or major metrorrhagia, if bleeding slightly stops, urgently use Dushen Tang (Single Ginseng Decoction). After ingestion, allow natural deep sleep; do not wake abruptly, then Yin blood will regenerate.