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When pathogenic warmth transforms into heat and moves outward, if it steams and steeps in the Qi level (Qi Fen), it manifests as symptoms such as vexation and heat, thirst, etc. If it blazes and scorches in the Ying level (Ying Fen), the blood is disturbed by heat, often overflowing from the lung collaterals causing hemoptysis (coughing up blood), being vomited out as hematemesis (vomiting blood), flowing upward through the clear orifices as epistaxis (nosebleed) or gingival bleeding, and flowing downward through the turbid orifices as hematuria (blood in urine) or hematochezia (blood in stool). All these cases occur because the blood is forced by pathogenic heat, unable to remain within its collaterals, thus overflowing upward and bursting downward. Since the blood has been lost externally, the pathogenic heat should also dissipate with the blood loss, and the disease condition should thereby subside; this is considered a favorable sign. However, if blood has been lost externally but the interior heat remains vigorous, accompanied by coma, delirium, and severe restlessness that does not significantly abate, it belongs to severe conditions. Investigating the causes, there are generally two reasons: first, the latent heat is heavy and the steaming and stagnation are too deep; although collateral blood overflows, much interior heat still remains latent; second, the Ying-Yin is deficient and damaged by blazing heat, leading to exhaustion of Yin-blood, which cannot support and expel the pathogen outward. For those with excess pathogen, cooling blood and draining pathogen is appropriate, using herbs such as Rhinoceros Horn (Xi Jiao), Rehmannia Root (Di Huang), Gardenia Fruit (Zhi Zi), Moutan Bark (Dan Pi), Honeysuckle Flower (Jin Yin Hua), Forsythia Fruit (Lian Qiao), Imperata Rhizome (Bai Mao Gen), and Biota Tops (Ce Bai Ye); for those with blood deficiency, nourishing blood and clearing heat is appropriate, using herbs such as Rehmannia Root (Di Huang), Peony Root (Shao Yao), Gardenia Fruit (Zhi Zi), Moutan Bark (Dan Pi), Donkey-Hide Gelatin (E Jiao), and Scrophularia Root (Xuan Shen). The main principle is always to cool the Yin and drain heat; for blood deficiency, add nourishment; for pathogenic excess, add clearing and draining. Only when bleeding stops and heat resolves simultaneously can the treatment be considered smooth and successful. In such cases, patients often seek rapid hemostasis and overuse cold-cooling agents, resulting in stopped bleeding but residual stasis in the upper collaterals causing chest and hypochondriac stiffness and pain, or residual stasis in the intestines causing foul diarrhea with purple-black clots. Even worse, stasis may transform into heat, changing into evening fever and morning chills, coughing with bloody sputum, presenting various signs of Yin damage. Ignorant practitioners, failing to examine carefully, mistakenly diagnose deficiency and indiscriminately administer tonics, causing the condition to linger and worsen, leading to death, which is truly lamentable.

Stasis remaining in the stomach and intestines is easy to disperse and resolve, as these organs are like broad highways, not located in minute and winding places, allowing medicinal power to easily unblock them. If stasis remains within the blood collaterals of the lungs and liver, the collateral pathways are narrow and winding; medicinal power cannot reach them instantly, and strong purgative agents are unsuitable. Only methods of unblocking collaterals, resolving stasis, and draining heat can slowly achieve results. For example, Cao Renbo's method of Qing Yu Re Tang (Clear Stasis-Heat Decoction) is most insightful, and students should imitate this usage (Qing Yu Re Tang ── Inula Flower (Xuan Fu Hua), Red Sandalwood (Jiang Xiang), Scallion White (Cong Bai), Reed Rhizome (Wei Gen), Loquat Leaf (Pi Pa Ye)).