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Xue Lizhai treated a fortune-teller named Zhang Donggu, who vomited one or two mouthfuls of blood after stepping out into the courtyard while discussing fate. He said: "I have had this condition for a long time, and it recurs whenever I exert myself." I surmised that this was damage to Lung Qi due to overexertion, and the blood must be corrupted; upon examination, this proved true. I prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Maidong (Ophiopogonis Radix), Wuweizi (Schisandrae Fructus), Shanyao (Dioscoreae Rhizoma), Shudi (Rehmanniae Radix Praeparata), Fushen (Poria cum Radice et Mycelium), and Yuanzhi (Polygalae Radix). After taking it, he recovered. The next morning, when he came to see me, he said: "After taking medicines such as Siwu Tang (Four Substances Decoction), Huanglian (Coptidis Rhizoma), and Shanzhi (Gardeniae Fructus), my fatigue became even worse. With just one dose from you, the hematemesis stopped immediately, and my spirit returned to normal. Why is this?" I replied: "The Spleen controls the blood, and the Lung governs Qi. This was damage to the Spleen and Lung due to overexertion, causing the blood to move recklessly. Therefore, I used the aforementioned herbs to strengthen the Spleen and Lung Qi, guiding the blood back to its source."

*Chu Shi Yi Shu* (Remnant Books of Master Chu) states: "The throat has orifices; hemoptysis kills. The intestines have orifices; hematochezia kills. Hematochezia can still be treated, but hemoptysis cannot be cured. Among those who drink urine, fewer than one in a hundred dies; among those who take cold-cooling herbs, not one in a hundred survives. Although blood belongs to Yin, what moves it is surely harmonious Yang."

I believe Master Chu’s theory of "harmonizing Yang" is indeed profound truth and exquisite words, which must not be ignored. As for the use of urine, it is indeed beneficial for descending fire by borrowing its properties in cases where pathogenic heat flares upward. However, if the injury lies in the Spleen and Stomach, or in conditions such as Yang deficiency with Yin excess, it is highly inappropriate. One should not assume that because fewer than one in a hundred die [from drinking urine], it can be applied universally.

Yang Renzhai stated: "Blood flows freely when heated; therefore, hemostasis often employs cooling herbs. Yet there are cases of Qi deficiency accompanied by cold, where Yin and Yang fail to guard each other, Ying Qi is deficient and scattered, and blood also moves erratically—this is what is meant by 'when Yang is deficient, Yin blood must flee.' Externally, there must be signs of cold. The treatment method should be to warm the interior. This allows the blood to naturally return to the meridians. Li Zhong Tang (Regulate the Middle Decoction) with added Nanmuxiang (Aucklandiae Radix), or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), can be used, with remarkable efficacy. Additionally, if dietary injury damages the Stomach, and Stomach deficiency fails to transport and transform, leading to rebellious Qi, hematemesis and epistaxis may also occur. Muxiang Lizhong Tang or Gancao Ganjiang Tang are generally suitable."

Xu Donggao commented on Wang Jiezhai: "Whenever excessive alcohol and sexual activity damage the True Yin of the Lung and Kidney, resulting in coughing with phlegm, hematemesis, epistaxis, hemoptysis, and spitting blood, mistakenly administering sweet-warm herbs like Renshen (Ginseng Radix) causes the disease to worsen daily. People of the world do not recognize this and often administer them, leading to many untreatable cases. Alas! This is a partial view, not a universal principle of the world. Just as I previously noted that Jiezhai’s discussions were mostly strong but weak in this specific aspect. Why? For all hemorrhagic conditions caused by excessive fire moving recklessly, avoiding sweet-warm herbs is indeed correct. But for those with deficient fire and severely weak constitution, how could one avoid using Renshen (Ginseng Radix) and Huangqi (Astragali Radix)? Ge Kejiu treated severe hematemesis by administering Dushen Tang (Single Ginseng Decoction) consisting of only one herb, thereby treating the deficiency. The Classics state: 'Deficiency requires tonification.' Thus, it was collected by Immortals and compiled into *Shi Yao Shen Shu* (Divine Book of Ten Herbs). Today, treating consumption-related hematemesis with this method yields miraculous effects of bringing the dead back to life. Then why was their use of Dushen Tang so divine? Furthermore, Danxi treated a fifty-year-old man with consumption cough and hematemesis using Renshen (Ginseng Radix), Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Baihe (Lilii Bulbus), Ejiao (Asini Corii Colla), Baishao (Paeoniae Radix Alba), Sangbaipi (Morus Cortex), Xingren (Armeniacae Semen Amarum), Beimu (Fritillariae Cirrhosae Bulbus), Gualou (Trichosanthis Fructus), Haishi (Aragonitum), Wuweizi (Schisandrae Fructus), and Tiandong (Asparagi Radix), resulting in recovery. Also, the Renshen Tang (Ginseng Decoction) in *Ju Fang* specifically treats hematemesis and epistaxis due to Stomach weakness. Are they all wrong? Generally, whether using tonification or purging in medication, one must examine the patient's deficiency or excess; then no application will be inappropriate. Why must sweet-warm herbs never be used!"