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Mr. Ni, a Xiao Lian (a title for successful candidates in the imperial examinations), was over forty years old. He had long suffered from damage to the Spleen Qi due to the fatigue of studying by lamplight and excessive mental exertion. He frequently experienced vomiting, which would occur upon overexertion. I often treated him with formulas such as Li Yin Jian (Nourish Yin Decoction) and Wen Wei Yin (Warm the Stomach Decoction), and he recovered immediately after taking them.

One day, at the end of the summer heat season, due to continuous social engagements, he fatigued his Heart and Spleen. Consequently, he began to vomit blood (hematemesis) and pass blood from the lower orifice (hematochezia). The clots were large, resembling hand-sized slices, varying in color from purple to red, and the volume was alarming. He urgently summoned me, but I happened to be away. He then invited a renowned physician of the time. The physician stated: "This is caused by fire arising from the Heart and Spleen due to fatigue, compounded by the peak of the summer heat season, where internal and external fires reinforce each other." He prescribed cold-natured herbs such as Rhinoceros Horn (Xi Jiao), Rehmannia Root (Di Huang), Child's Urine (Tong Bian), and Anemarrhena Rhizome (Zhi Mu). After two doses, the vomiting worsened significantly, the pulse became tighter and more rapid, and the patient grew exhausted and critical. The physician remarked: "The pulse and symptoms are both adverse; there is no hope for survival, and it cannot be treated." The patient's son, terrified, begged me again. I went to examine him. Seeing the severity of the condition, but unable to refuse due to our prior friendship, I administered a large dose of Ginseng Root (Ren Shen), Prepared Rehmannia Root (Shu Di Huang), Dried Ginger (Gan Jiang), and Licorice Root (Gan Cao).

After the first dose, there was no effect. After the second dose, the nausea and vomiting subsided slightly, and a faint sign of life appeared in the pulse. Subsequently, I added Aconite Root (Fu Zi) and Charred Ginger (Pao Jiang), each 2 qian, Ginseng Root and Prepared Rehmannia Root, each 1 liang, Atractylodes Macrocephala Rhizome (Bai Zhu) 4 qian, Honey-fried Licorice Root (Zhi Gan Cao) 1 qian, and Poria (Fu Ling) 2 qian. This was administered at dusk, and the patient fell into a deep sleep. By the fourth watch of the night (midnight), another dose was given, after which both vomiting and bleeding stopped. I then intensified the warming and tonifying treatment. After ten days of regulation, his health returned to normal.

When I first used this prescription, a colleague was present and was shocked, unable to comprehend my reasoning. Only after the patient recovered did he become convinced, saying: "If you had not been here initially, the patient would certainly have died from the child's urine, rhino horn, Coptis Rhizome (Huang Lian), and Anemarrhena Rhizome. People would still praise the previous doctor, saying, 'He originally stated that the pulse and symptoms were adverse and incurable.' Your insight is truly superior and unmatched!" Alas! Child's urine most easily induces vomiting; Rhino Horn, Anemarrhena, and Coptis most easily damage the Spleen. Although the season was characterized by "two fires" (summer heat and labor-induced fire), the syndrome was not caused by these fires. In this person and this case, the bleeding was caused by fatigue damaging the Spleen, leading to Spleen and Stomach Yang Deficiency, where Qi failed to control the blood. Using cold-natured herbs would have destroyed the Spleen and caused death. If killing someone in this manner brings praise, how can one clarify such unjust situations prevalent in the world? Later, several patients with surnames like Shi presented with identical syndromes, all of whom I successfully treated using Liu Wei Hui Yang Yin (Six-Ingredient Decoction to Restore Yang). This is indeed the ultimate truth, though people considered it strange. Therefore, I record it here.