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Chronic pyelonephritis belongs to the category of "Lao Lin" (Lin syndrome caused by fatigue or chronic illness) in Traditional Chinese Medicine. Clinically, it is mostly caused by excessive use of cold and cool medicines damaging Yang Qi. The syndrome manifests as Spleen-Yang deficiency or Kidney-Yang deficiency; at this time, if one continues to seek treatment with cold and cool medicines, the disease will be difficult to cure. For those with hydronephrosis, those whose urine culture bacteria types change frequently, and those with recurrent leukocytes and proteinuria, clinically one should not merely see the hydronephrosis and administer diuretics, nor should one see a certain bacterium and only look for specific antibacterial or anti-inflammatory drugs. Instead, one should correctly prescribe appropriate formulas based on the proportion of Yin and Yang of the Zang-Fu organs. For example, for Kidney-Yang deficiency, Shiyi Dihuang Tang (Ten-Ingredient Rehmannia Decoction) is prescribed; for Spleen-Yang deficiency with abundant dampness, Weiling Tang (Stomach-Coptis Decoction) is prescribed; for abundant damp-heat, Ganlu Xiaodu Dan (Sweet Dew Detoxifying Pill) is prescribed, etc.

Blood Disorders
Twenty Methods for Treating Hematemesis
Hematemesis is always caused by injury to the Stomach collaterals. Due to the influence of diseases of the Stomach itself or other Zang-Fu organs, the Stomach collaterals are damaged, blood overflows into the Stomach, causing Stomach-Qi to rebel upward. Blood follows the rebellious Qi and is vomited from the mouth, forming the syndrome of hematemesis. The causes of hematemesis are complex, mainly including: binge eating or irregular meals leading to accumulation of heat in the Stomach and damage to Stomach collaterals; Liver-Qi stagnation causing collateral obstruction, which turns into fire after a long time, rebelling against the Stomach and damaging Stomach collaterals; excessive labor and fatigue leading to deficiency of Middle-Jiao Qi, where Qi fails to control blood causing it to overflow into the Stomach; external contraction of Wind-Heat or Wind-Cold turning into heat after a long time, invading the Blood level; warm diseases or summer-heat causing heat to sink into Ying and Blood levels; excessive sexual desire leading to Yin deficiency with hyperactive Fire, forcing blood to move recklessly, etc. All the above reasons can lead to or trigger hematemesis.

Since the causes of hematemesis are relatively complex, its treatment principles and methods are diverse. Summarized, there are the following twenty methods:
1. Treating the Stomach Method
Hematemesis is mostly bleeding from the stomach opening, so treating the Stomach is naturally the primary method.
2. Treating the Liver Method
Whenever hematemesis is accompanied by pain in the waist and hypochondrium, treating the Liver should be the main approach because the hypochondrium is the location of the Liver, and waist-hypochondriac pain indicates that the blood comes from the boundary of the Liver, so treating the Liver is appropriate.
3. Treating the Lung Method
Whenever hematemesis is accompanied by chest and back pain, treating the Lung should be the main approach because the Lung is located between the back and the thoracic diaphragm, and chest-back pain indicates that the blood comes from the boundary of the Lung, so treating the Lung is appropriate.
4. Treating the Chong Mai Method
The Chong Mai (Penetrating Vessel) is the Sea of Blood, and the Chong Mai belongs to the Yangming Meridian. There is no case where Chong Qi rebels upward without blood also rebelling upward. Therefore, Zhang Zhongjing considered treating the Chong Mai essential for treating hematemesis.
5. Stopping Bleeding Method
Blood in the human body is naturally hidden and is an important tissue of the body. When blood loss reaches 1/4 to 1/3 of the total volume, there is a danger to life. The ancients said, "Preserve one part of blood, preserve one part of life." Therefore, for all bleeding syndromes, stopping bleeding is certainly an essential and common method.
6. Dispelling Stasis Method
After bleeding stops, the blood that has moved in the chest cannot return to its original path. If this forms a syndrome of pain due to blood stasis, it should be eliminated. Because blood stasis can block the airway and obstruct vitality, if blood stasis is not removed, hematemesis will easily recur, and over time it may turn into a syndrome of bone-steaming consumption. Therefore, blood stasis should be dispelled immediately.
7. Calming Blood Method
After bleeding stops and stasis is resolved, if blood occasionally vomits again within a few days or dozens of days, this is a phenomenon where blood cannot remain in its normal state. Therefore, the method of calming blood should be used for treatment.
8. Tonifying Blood Method
After hematemesis, blood is inevitably deficient, so tonifying blood is appropriate.
9. Promoting Blood Circulation is Preferable to Stopping Bleeding
Because hematemesis caused by blood not following the meridians is due to Qi failing to descend, the method of descending Qi and promoting blood circulation should be used, and the blood will stop spontaneously. If stopping bleeding is urgently applied, it easily leads to blood coagulation,必定 causing fever, chest and hypochondriac pain, and making the disease increasingly entrenched.
10. Nourishing the Liver is Preferable to Attacking the Liver
Because the Liver stores blood, hematemesis is a failure of the Liver's function. Nourishing the Liver calms Liver Qi and allows blood to have a destination; attacking it makes the Liver deficient and unable to store blood, causing bleeding to continue indefinitely.
11. Descending Qi is Preferable to Descending Fire
Because Qi is Fire, and Fire is Qi, descending Qi descends Fire. Blood follows Qi, so there is no risk of overflowing from the upper orifices. If bitter-cold medicines are used to descend Fire, they damage the Spleen and Stomach instead. The more deficient the Spleen becomes, the less it can control blood, and bleeding continues.
12. Clearing Heat, Purging Fire, and Generating Fluids Method
For those who drink excessively or eat fried and rich foods causing hematemesis, symptoms include rapid and slippery pulse, dry mouth, irritability in the chest, and difficulty in urination and defecation. Treatment should clear heat and purge fire, generate fluids and stop bleeding, using Baihu Tang (White Tiger Decoction) plus Yinchen, fried Gardenia, Rhubarb, and Lotus Node.
13. Releasing the Exterior Method
For hematemesis caused by external Wind-Cold or Wind-Heat pathogens invading the Blood level, symptoms include headache, aversion to cold with fever, and floating-tight pulse (for Wind-Cold); or aversion to wind and floating-rapid pulse (for Wind-Heat). For Wind-Cold, acrid-warm dispersal of cold is appropriate, using Mahuang Renshen Shaoyao Tang (Ephedra, Ginseng, and Peony Decoction); for Wind-Heat, dispersing Wind and clearing heat is appropriate, using Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Schizonepeta, Saposhnikovia, Angelica, White Peony, Moutan, Coptis, Anemarrhena, Gypsum, and Apricot Kernel.
14. Clearing Warmth, Detoxifying, Cooling Blood, and Dispelling Stasis Method
For warm diseases where heat enters Ying and Blood levels, symptoms include thirst, mental restlessness, aversion to heat and light, short dark urine, turbid stool, and slippery-rapid pulse. Treatment should clear warmth and detoxify, cool blood and dispel stasis, using Shengjiang San (Ascending and Descending Powder) plus Peach Kernel, Moutan, Trichosanthes Root, Rehmannia, Coix Seed, raw Gypsum, Apricot Kernel, and Licorice. Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) also treats this.
15. Clearing Heat and Promoting Dampness Resolution Method
For hematemesis caused by contracting Summer-Dampness pathogens during hot weather, where Dampness and Heat combine to form Summer-heat, symptoms include fever and irritability. Treatment should focus on clearing heat and promoting dampness resolution, using Shengjiang Qinghua Tang (Ascending and Descending Clearing and Transforming Decoction) plus Stephania, Akebia, and Coix Seed; for mild cases, remove Rhubarb.
16. Soothing the Liver, Cooling Blood, and Resolving Depression Method
For hematemesis caused by anger injuring the Liver, where Liver depression transforms into fire rebelling horizontally, treatment should soothe the Liver, cool blood, and resolve depression, using Danzhi Xiaoyao San (Moutan and Gardenia Free and Easy Wanderer Powder) plus Green Tangerine Peel, Oyster Shell, Coptis, and Gentian. For severe fire, Danggui Longhui Wan (Angelica Longdan Pills) treats it.
17. Strengthening the Spleen, Benefiting Qi, and Nourishing Blood Method
For hematemesis caused by labor fatigue, irregular meals, and worry/sorrow/depression, symptoms include palpitations, poor appetite, shortness of breath, and empty irritability. Treatment should strengthen the Spleen, benefit Qi, and nourish blood, using Guipi Tang (Restore the Spleen Decoction). For Middle Earth deficiency-cold, add baked Ginger; for deficiency-heat, add Arnebia and Gardenia.
18. Nourishing Yin and Tonifying the Kidney Method
For hematemesis caused by excessive sexual desire leading to Yin deficiency with hyperactive Fire, symptoms include fever at night, night sweats, nocturnal emissions, tinnitus, insomnia, and fine, rapid, hollow, or string-like pulses in all six positions. Treatment should nourish Yin and tonify the Kidney, using Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Coptis, Lotus Node, Donkey-hide Gelatin, and Schisandra.
19. Warming Yang and Benefiting Qi Method
For hematemesis caused by deficiency-cold, it is due to Yang failing to control Yin, causing Yin blood to spill out. Symptoms must include cold blue hands and feet, loose stools, urinary incontinence, fine-deep-slow-choppy pulse, pale complexion, pale lips and mouth, or internal cold with external heat. Treatment should warm Yang and benefit Qi, using Gancao Ganjiang Tang (Licorice and Ginger Decoction).
20. Invigorating Blood and Nourishing Blood Method
For hematemesis caused by trauma or straining, there must be a history of trauma or forced heavy lifting/racing. Treatment should invigorate blood and nourish blood, using Siwu Tang (Four Substance Decoction) with modifications.

Differentiation and Treatment of Fever in Blood Disorders
Fever is a common clinical symptom, visible in the course of various exogenous and endogenous diseases. It is even more common in blood disorders (blood stasis, blood deficiency, bleeding, etc.). Due to different characteristics and accompanying symptoms, the nature of fever often differs, and treatment methods vary, requiring careful observation.
1. In patients who have lost blood, slight body heat and apparent sweat on skin and hair indicate Yang coming to seek Yin and Water coming to join Blood, a sign of self-healing.
2. In patients who have lost blood, body heat accompanied by dizziness and head sweating indicates Yang Qi constrained in the Blood level. Treatment should resolve the constraint, causing slight sweating over the whole body, so Qi reaches the exterior, Yang does not oppress Yin, and the disease heals. Xiao Chaihu Tang (Minor Bupleurum Decoction) is suitable.
The above two items both refer to fever during bleeding, mentioning only one point; details are found in respective bleeding syndromes.
3. Alternating chills and fever accompanied by stabbing pain indicates blood stasis in the Couli (interstices). Treat with Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Angelica, White Peony, Moutan, Peach Kernel, Safflower, and Schizonepeta; Taonusan (Peach Bud Powder) also treats it.
4. Fever, thirst, irritability, resembling Baihu Tang (White Tiger Decoction) syndrome, accompanied by limb stabbing pain, indicates blood stasis in the muscles. Treat with Danggui Buxue Tang (Angelica Tonifying Blood Decoction) combined with Jiaji Huashang Tang (White Peony and Licorice) plus Peach Kernel, Safflower, Bupleurum, Anemarrhena, and Gypsum; Xuefu Zhuyu Tang (Drive Out Stasis in the Mansion of Blood Decoction) also treats it.
5. Tidal fever at Ding-Shi (3-5 PM), clarity during the day, and delirium at night indicates blood stasis in the Fu organs (Blood Chamber). Tao Ren Cheng Qi Tang (Peach Kernel and Cathartic Decoction) treats it; Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Peach Kernel, Moutan, and White Peony also treats it.
6. Bone-steaming consumption fever, burning palms, black eyes, broken hair indicates a critical syndrome of blood stasis in the Zang organs (Liver). Treat with Chaihu Qinggu San (Bupleurum Clearing Bone Powder) plus Peach Bud, Amber, Drynaria, and Moutan.
The above four items are all fevers due to blood stasis after blood loss.
7. Fever with sweating indicates Blood deficiency with excess Qi leaking outward. Nighttime fever is dominated by the Blood level; Blood deficiency causes nighttime fever. Fever at Yin-Mao hours (3-7 AM), belonging to Shaoyang, occurs when Liver Blood is deficient and Ministerial Fire of Shaoyang flares at its peak time. Treat with Digupi San (Lycium Bark Powder) plus Bupleurum, Artemisia Annua, Picrorhiza, Poria, and Licorice.
8. Tidal fever at Ding-Shi (3-5 PM) indicates Blood deficiency with Fire in the Uterus combining with Yangming Dryness-Heat. Treat with Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction).
9. Afternoon fever accompanied by dry skin/hair, sores in mouth/throat, seminal emission, and dysuria indicates Blood deficiency with insufficient Body Fluids and excess Heat. Treat with Wu Zheng Tang (Five Steaming Decoction).
10. Postpartum fever or fever after blood loss is treated with Siwu Tang (Four Substance Decoction) plus Fried Ginger.
11. After blood loss, Kidney Yin insufficiency with True Yang floating outward, fever accompanied by panting, indicates Yin failing to retain Yang and Yang failing to enter Yin. Treatment should guide Yang from Yin. Treat with Erjia Longgu Tang (Two-Added Dragon Bone Decoction) plus Schisandra, Ophiopogon, and Donkey-hide Gelatin, or Santang Tang (Three Capabilities Decoction) plus Salt-fried Cinnamon, Mulberry Leaf, Poria, White Peony, Cordyceps, Cornus, Achyranthes, Schisandra, Anemarrhena, Agarwood, and Turtle Shell.
The above five items are all fever syndromes after blood loss due to Blood deficiency or other deficiency syndromes caused by Blood deficiency.
12. Fever in palms, soles, and abdomen accompanied by chest fullness, hiccups, irregular bowel movements, and irritability at Ding-Shi and nighttime indicates Food Stagnation Fever. Treatment should eliminate it using Magnolia Bark, Magnolia Fruit, and Rhubarb. This is a mixed deficiency-excess syndrome after blood loss, specifically Excess-Heat within Blood deficiency.

Aplastic Anemia
Three Major Syndromes of AA: Blood Deficiency, Bleeding, and Infection
Although treating AA requires tonification, tonification is embedded in harmonizing, eliminating, and clearing.
Aplastic anemia, abbreviated as "AA," is a critical and difficult disease caused by dysfunction of the human hematopoietic system and a significant reduction in blood cells due to various reasons. Although traditional Chinese medicine literature does not have the name "AA," it contains rich and detailed records of the syndrome characteristics, pathogenesis, diagnosis and treatment methods, established formulas, patent medicines, and single/herbal prescriptions for this disease. This disease basically belongs to the categories of "Xu Lao" (Deficiency Consumption), "Xu Sun" (Deficiency Damage), and "Xue Zheng" (Blood Disorders) in TCM. Old Li believes that clinically, the main problems of "AA" are three aspects: first, anemia (Qi and Blood deficiency); second, bleeding; third, infection (exogenous fever). These three are not parallel relationships but have subtle causal, root-branch, subordinate, and associative relationships. The summary of Old Li's discussion on the relationship between Blood deficiency and the onset of "AA," the main causes of Blood deficiency, and the relationship between Blood deficiency, bleeding, and infection is as follows:
1. The root syndrome of "AA" is Blood deficiency, attributed to Spleen, Kidney, and Qi.
Among the three major syndromes of "AA," Qi and Blood deficiency is the root of the disease and the main aspect of the contradiction. Old Li believes that all deficiency and consumption diseases ultimately boil down to Qi and Blood deficiency; "AA" is no exception. He believes that although blood deficiency in the human body is related to the Five Zang organs (Heart, Liver, Spleen, Lung, Kidney), regarding Blood deficiency in "AA," it should mainly be attributed to the Spleen and Kidney and the prosperity of Qi. TCM holds that "Blood is the essence of water and grain, generated in the Spleen," and "The Middle Jiao receives Qi and extracts juices, transforming them into red, which is Blood." That is, the Middle Jiao accepts Qi and refined substances from food and drinks, transforms them into red, creating blood. Therefore, dysfunction of the Middle Jiao Spleen (Stomach) is the direct cause affecting hematopoiesis and forming anemia. "The Kidney stores Essence, governs Bones, and generates Marrow," "Blood is transformed from Essence," "Bones are the residence of Marrow," "Marrow fills the bones," "When Marrow is solid, Qi and Blood follow," "The essence fluids of grains combine to form blood, seeping internally into bone cavities to supplement brain marrow." These records explain the relationship between the Kidney system (Kidney, Bones, Marrow) and blood. Marrow has a direct relationship with hematopoiesis; Marrow is stored in Bones, and Bones are governed by the Kidney. Thus, the strength or weakness of Kidney function can affect the marrow's ability to generate Essence and blood. Furthermore, "Qi" is closely related to hematopoietic function. Qi and Blood are closely related; Qi belongs to Yang, Blood belongs to Yin. "Yin is the foundation of Yang, Yang is the commander of Yin," "When Yang grows, Yin grows," "Form-blood cannot generate itself; it is born from formless Qi." It can be seen that blood generation depends on Qi, and Qi promotes hematopoiesis. This is the true reason why, clinically when treating Blood deficiency, large doses of Qi-tonifying herbs (such as heavily using Astragalus in Danggui Buxue Tang) are often added to blood-nourishing herbs, further promoting blood generation.
2. Although bleeding and infection are main symptoms, internal deficiency of Righteous Qi is the cause.
Although bleeding and infection are the two main symptoms of "AA," relative to Blood deficiency syndrome, they can only be considered branch manifestations. The reason is actually Qi and Blood depletion and internal deficiency of Righteous Qi. As stated in the *Neijing*, "Where evil gathers, Qi must be deficient," and "When Righteous Qi exists internally, evil cannot interfere." Blood circulates in the vessels without escaping mainly due to the securing effect of Qi on Blood. If Qi is deficient and cannot normally secure blood, it easily leads to various bleeding conditions, known as "Qi failing to control blood." Internal depletion of Essence and Qi, dual deficiency of Qi and Blood, makes it easiest for external pathogens to take advantage of the deficiency and cause infection, because Qi and Blood are important components of Righteous Qi, and the strength of Righteous Qi plays a decisive role in resisting external pathogens and preventing infection. Additionally, exogenous fever (infection), as well as Yin deficiency with internal heat, or forcing blood to move recklessly, heat damaging blood collaterals, can all cause bleeding. Long-term bleeding inevitably leads to Qi departing with Blood, making Qi and Blood more deficient and more susceptible to infection, thus forming a vicious cycle. This is the mutual relationship among the three aspects of "AA": Blood deficiency, bleeding, and infection.
The key to treating "AA" lies in how to grasp and handle these three issues. Old Li believes that among the three, Blood deficiency is the root, and bleeding and fever are the branch. Generally, Blood deficiency is the main contradiction, so benefiting Qi and nourishing Blood is the fundamental treatment principle, meaning "treating disease must seek its root" and "when slow, treat the root." However, it must be specially emphasized that once an "AA" patient presents with severe bleeding and high fever from infection, the contradiction has transformed, and bleeding and fever become the main contradictions, endangering the patient's life. At this time, the treatment focus should be placed on bleeding and infection, with stopping bleeding and clearing heat as the treatment principles, meaning "when urgent, treat the branch."
Old Li also emphasizes that the above are only some fundamental methods and general principles for treating AA. Clinical reality is often more complex. The three major symptoms often occur simultaneously, and deficiency/excess and cold/heat often appear alternately and cannot be neglected. Therefore, in specific treatment principles and methods, it is often appropriate to address both root and branch. Although "AA" is rooted in Qi and Blood deficiency and treating "AA" cannot do without tonification, because this disease often involves Qi stagnation, blood stasis, phlegm accumulation, food stagnation, and fire-heat, in certain stages, harmonizing, eliminating, and clearing methods must be paired, or when branch symptoms are urgent, harmonizing, eliminating, and clearing methods are temporarily primary, with tonifying deficiency as secondary.
Long-term clinical practice has enabled Old Li to accumulate rich experience in differentiating and treating mixed syndromes of "AA," especially in medication rules. These are summarized and introduced below: I. Anemia (I) Key Points of Syndrome Differentiation. The key points of anemia differentiation should be carefully observed from three aspects: complexion, tongue appearance, and pulse, and differentiated through comparative analysis.
1. Observing Complexion
Complexion changes in anemia roughly fall into the following four types:
(1) Bright White: Mostly Qi and Yin dual deficiency. Among them, bright white with oily shine, white with much sweat, and white showing tender red indicate dual deficiency of Qi and Yin. If white with oily texture, Yin deficiency is greater than Qi deficiency; if white with much sweat, Qi deficiency is greater than Yin deficiency; if white showing tender red, Yin deficiency with Fire; if white with dry skin, Qi deficiency combined with dual deficiency of Yin and Yang.
(2) Withered Yellow: Mostly accompanied by Spleen deficiency. Among them, withered yellow yet moist indicates Spleen deficiency with Dampness; withered yellow showing green indicates Wood of Liver overcoming Earth of Spleen, with Spleen Dampness greater than Liver depression.
(3) Blue/Green: Mostly related to Liver disease. Among them, blue-green with slight yellow indicates Blood deficiency, blood stasis, and Kidney deficiency, with Blood deficiency and blood stasis greater than Kidney deficiency; blue-black with slight yellow indicates simultaneous disease of Liver, Spleen, and Kidney, with Liver and Kidney disease greater than Spleen disease.
(4) Black: Mostly related to Kidney disease. Among them, black, dull, and dry indicates Kidney-Yang deficiency; black, dark, and moist indicates Kidney-Yin deficiency; black with slight green indicates simultaneous disease of Liver and Kidney, with Kidney disease greater than Liver disease.
2. Tongue Appearance