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(There are thirteen articles in total; for all subsequent cases involving various types of bleeding, one should seek the underlying principles within this category.)

1. In treating hematemesis (vomiting blood), one must understand the severity of the condition. If there is an occasional injury but the root vitality remains unshaken, the condition is mild and easy to treat. One should clear heat or nourish as indicated by the specific injury; with appropriate medication, recovery can be achieved without concern. However, if chronic fatigue and excessive damage lead to severe deficiency of Yuan Qi (Original Qi) and failure of True Yin to remain secure, it constitutes a critical syndrome. This occurs because of negligence at the onset; if one fails to exercise caution even after illness has manifested, a favorable outcome is unlikely. For those suffering from this, relying solely on medicinal power without careful attention and prudence makes recovery difficult.

2. Regarding hematemesis and hemoptysis (coughing up blood), if caused by exhaustion leading to Qi deficiency with a calm pulse, or a slightly wiry and weak pulse, and neither constituting a Fire syndrome nor Qi rebellion, but rather spontaneous bleeding, this results from internal damage to True Yin and injury to the collaterals. One should use sweet and mellow herbs to tonify Yin and nourish the collaterals, allowing Ying Qi (Nutritive Qi) to gradually consolidate, thereby stabilizing the blood. Suitable formulas include Yi Yin Jian (One Yin Decoction), Zuo Gui Yin (Left Restoring Drink), Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill), or Xiao Ying Jian (Small Nourishing Decoction), selected according to circumstances. If the deficiency lies in the Qi aspect, Wu Fu Yin (Five Blessings Drink) or Da Bu Yuan Jian (Great Tonifying Original Decoction) are optimal. Such syndromes strictly contraindicate cold-cooling herbs and moving-scattering herbs, as these are unsuitable for deficiency-damage conditions.

3. In cases of hematemesis and hemoptysis accompanied by thirst, sore throat, restlessness, preference for cold, slippery pulse, solid stool, and dark hot urine, this indicates Water failing to control Fire, resulting from Yin deficiency and Yang hyperactivity. Treatment should focus on nourishing Yin and strengthening Water, with slight assistance from cooling herbs. Suitable formulas include Er Yin Jian (Two Yins Decoction), Si Yin Jian (Four Yins Decoction), modified Yi Yin Jian, Sheng Di Huang Yin Zi (Rehmannia Root Drink), or Tian Men Dong Wan (Asparagus Fern Pill), chosen based on the affected organ's Qi. If the heat is not severe, Yi Yin Jian, Zuo Gui Yin, or Liu Wei Di Huang Tang are appropriate. These syndromes strictly contraindicate acrid-warm herbs such as Chuan Xiong (Ligusticum Rhizome), Dang Gui (Angelica Sinensis), Bai Zhu (Atractylodes Macrocephala), Du Zhong (Eucommia Bark), Po Gu Zhi (Cistanche Fruit), Xiang Fu (Cyperus Rhizome), Sha Ren (Amomum Fruit), Sheng Jiang (Fresh Ginger), and Rou Gui (Cinnamon Bark).

4. When hematemesis is entirely caused by excess Fire forcing blood upward, observe the intensity of the Fire. For mild Fire, Ju Fang Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction from the Bureau Formulary) or Qing Hua Yin (Clearing Transformation Drink) should be used. For violent Fire where the root is undamaged, Chou Xin Yin (Removing Fuel Drink), Xi Xin Yin (Moving Away Fuel Drink), or Huang Lian Jie Du Tang (Coptis Detoxification Decoction) and San Huang Wan (Three Yellows Pill) are suitable. If Stomach Fire is excessive, causing irritability, thirst, headache, slippery pulse, Qi stagnation, and persistent hematemesis, Bai Hu Tang (White Tiger Decoction) or Chou Xin Yin is indicated. If Stomach Fire is blazing combined with Yin deficiency and fluid depletion, Yu Nu Jian (Jade Woman Decoction) is appropriate. If Yangming Excess Heat is severe, accompanied by constipation, abdominal distension, and descending Qi obstruction, Ba Cui Xi Jiao Di Huang Tang (Rhino Horn and Rehmannia Decoction from Extracts), Liang Ge San (Cooling the Diaphragm Powder), or Tao Ren Cheng Qi Tang (Peach Kernel Draining-Down Decoction) may be used. However, such cases are rare; they must be confirmed accurately before use, avoiding rashness. All Fire syndromes benefit from drinking Child Urine (Tong Bian).

5. Hematemesis caused by excessive alcohol consumption should be treated with Xi Xin Yin, Qing Hua Yin, or Ge Hua Jie Cheng Tang (Kudzu Flower Relieving Intoxication Decoction) added with Huang Lian (Coptis Rhizome) and Dan Pi (Moutan Cortex).

6. Anger injuring the Liver moves Liver Fire, which carries blood upward, or moves Liver Qi, causing Qi rebellion and blood rushing, both leading to vomiting blood. Excessive Liver Fire presents with irritability and heat-related pulse signs. Herbs such as Shao Yao (Peony Root), Sheng Di Huang (Rehmannia Root), Dan Pi, Zhi Zi (Gardenia Fruit), Ze Xie (Alisma Rhizome), Huang Qin (Scutellaria Root), and Huang Lian are used to descend Fire, clearing the blood. Liver Qi rebellion presents with chest and hypochondriac pain and fullness. Herbs such as Shao Yao, Sheng Di Huang, Qing Pi (Green Tangerina Peel), Chen Pi (Aged Tangerina Peel), Zhi Ke (Bitter Orange Fruit), Bei Mu (Fritillaria Bulb), and Ze Xie are used to move Qi, clearing the blood. If Fire arises from Qi rebellion, Hua Gan Jian (Transforming Liver Decoction) is best. If anger has subsided, avoid further scattering herbs that damage true Qi. If Liver Fire is pacified, avoid overusing bitter-cold herbs that damage Yuan Yang. Since Liver Qi pathology often insults the Spleen and Earth, it frequently causes Spleen-Stomach injury and loss of Ying Blood security. If there is no distension or fire, but a deficient pulse and mental fatigue with spontaneous bleeding, the pathology lies in the Spleen; treatment should focus on regulating Middle Qi. Wu Yin Jian (Five Yins Decoction) or Wu Fu Yin are suitable. If Fire fails to generate Earth, Li Zhong Tang (Regulate the Middle Decoction) or Li Yin Jian (Regulate Yin Decoction) are essential. Do not focus solely on suppressing the Liver just because the initial cause was anger.

7. Excessive worry and thought damaging the Heart and Spleen, leading to hematemesis and hemoptysis, are rarely Fire syndromes. Symptoms may include shortness of breath, timidity, emaciation, depression, lack of appetite, hunger without desire to eat, or restless sleep due to frightened spirit. These result from Middle Qi deficiency failing to contain blood. Urgent treatment of the root is required, not the branch. Wu Fu Yin or Wu Yin Jian are suitable. If Qi sinks with slight stagnation, Gui Pi Tang (Restore the Spleen Decoction) is indicated. If Yang deficiency exists, Li Zhong Tang or Li Yin Jian are appropriate. If chronic fatigue and overthinking, frequent vomiting, or diarrhea suddenly lead to hematemesis and lower bleeding, this is Spleen deficiency failing to control blood, not a Fire syndrome. Liu Wei Hui Yang Yin (Six-Ingredient Returning Yang Drink) with a large dose of Bai Zhu is suitable; cold-cooling drugs must be avoided.

Summer-toxin harming people often causes epistaxis (nosebleed) and blood loss, as summer Qi connects to the Heart and Fire-toxin attacks the Lung. Summer damages the Heart, and heat damages Qi, resulting in a deficient pulse, timidity, fatigue, and faint breathing. Overusing cold-cooling herbs thinking it is merely heat will further damage Qi, causing great harm. Sheng Mai San (Generate Pulse Powder) or Ren Shen Tang (Ginseng Decoction) are suitable. For severe Qi deficiency, add Ren Shen (Ginseng Root) and Huang Qi (Astragalus Root). If Fire is severe with heat, thirst, and oppression, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) are indicated. If Qi deficiency is not severe, Ju Fang Xi Jiao Di Huang Tang or Pi Pa Ye San (Loquat Leaf Powder) are suitable.

8. Ge Yang (Gridlock Yang) blood loss syndromes are often due to excessive sexual activity and fatigue, causing True Yang to lose security in the Yin aspect. Rootless deficient Fire floats upward, presenting with upper heat and lower cold, red face, panting, restlessness, massive hematemesis or epistaxis, and continuous blood loss. However, the six pulses are minute, limbs are cold, urination is clear and profuse, and stool is loose. This is a Ge Yang deficient Fire syndrome. Urgently guide Fire back to its source using Zhen Yin Jian (Settling Yin Decoction) or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill); the Fire will descend and blood will stabilize. Using cold-cooling herbs will lead to Yang extinction and death.

9. Blood vomited that is black and dark indicates stagnant blood out of position, not moved by Fire. A pale face, faint breathing, slow-weak pulse, and cool body indicate Spleen-Kidney Qi deficiency failing to control blood, not a Fire syndrome. Using blood-cooling agents will lead to danger. The *San Yin Fang* states: Li Zhong Tang can stop Stomach-injury hematemesis because it warms the middle, regulates Yin and Yang, and harmonizes Stomach Qi. If deficiency is in the Yin aspect, Li Yin Jian is most suitable.

10. Sudden massive hematemesis or epistaxis with blood gushing leads to blood loss and concurrent Qi collapse, a critical emergency due to severe internal injury. At this moment, prioritize Qi. Formidable blood cannot regenerate immediately, but formless Qi must be urgently secured. As long as Qi does not completely collapse, life can be preserved, and blood will gradually regenerate. Urgently administer 1-2 liang of Ren Shen powder mixed with 1 qian of refined flour, diluted with warm water or well water to a thin paste, taken slowly. Alternatively, strong Du Shen Tang (Single Ginseng Decoction) taken slowly is effective. This follows the great principle of benefiting Qi in blood collapse and generating Yin through Yang.

11. For blood rebelling to the Upper Jiao, forming purple-black clots, causing pain or oppression, and accumulating without dispersing, moving and scattering methods are suitable, or inducing vomiting is beneficial. Generally, treating blood disorders contraindicates acrid-scattering herbs to avoid disturbing blood. However, for stagnant blood, such methods are permissible. Si Wu Tang (Four Substances Decoction) added with Xiang Fu, Rou Gui, Su Mu (Sappan Wood), and Hong Hua (Carthamus Flower) is effective. Drinking Leek Juice also effectively moves stasis. If constrained Fire causes blood stagnation, adding Chao Shan Zhi (Stir-fried Gardenia Fruit) to Si Wu Tang clears Stomach heat and blood.

12. For intractable hematemesis, drinking Tong Bian (Child Urine) is most effective. Alternatively, crush Ce Bai Ye (Biota Top Branches), mix two parts Tong Bian with one part wine, and drink warm. This greatly stops bleeding.