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The *Yuan Bing Shi* (Treatise on the Original Causes of Disease) states: Nasal bleeding (Nasal hemorrhage, Bi Xue) occurs when Yang-heat pathogen is constrained and invades the Foot-Yangming Meridian, causing excessive heat in the upper body and forcing blood to flow recklessly. "Blood overflow" refers to blood flowing upwards. The Heart governs the blood vessels; therefore, when heat is extreme, blood qi becomes excessive and flows recklessly. Some claim that vomiting purple, coagulated blood indicates a Cold syndrome, which is incorrect. This is not due to cold condensation, but rather because extreme heat scorches the blood, making it thick and turbid. Furthermore, when heat reaches its peak, Water elements act to control it, resulting in a color that is red mixed with black, appearing purple. "Blood discharge" refers to blood in stool or urine caused by heat pathogens lodging in the Lower Jiao. Nasal bleeding involves the expulsion of turbid blood; "turbid" implies impurity. When Heart-fire is extreme, blood qi is excessive, and severe upward rushing of heat causes blood overflow. When heat intensity is extreme, it dries the blood and makes it turbid; when this harms the regulatory mechanism, the color mixes with black to appear purple.

Cheng Wuji stated: In Shanghan (Cold Damage), nasal bleeding occurs because the pathogen cannot be dispersed, becoming congested in the meridians and forcing the blood, thereby causing nasal bleeding. Using Guizhi Tang (Cinnamon Twig Decoction) or Mahuang Tang (Ephedra Decoction) to treat nasal bleeding does not directly treat the bleeding itself, but rather aims to disperse the pathogen within the meridians. Regarding "accumulated blood" (Xu Xue), it refers to blood coagulating and stagnating in the Lower Jiao without circulating. Blood stagnating in the upper body causing hematemesis is called "Bo Jue" (Thin Frenzy); blood remaining in the lower body causing stasis is called "Xu Xue". This results from Taiyang disease where the pathogen follows the meridians into the interior, creating stagnant heat inside. The blood is bound by heat and fails to circulate, accumulating in the Lower Jiao. The Classic states: In Taiyang disease lasting seven to eight days, if exterior symptoms persist, the pulse is faint and deep, there is no formation of Jie Xiong (Chest Binding), and the patient exhibits mental restlessness akin to madness, it is because heat resides in the Lower Jiao. The lower abdomen should be hard and full. If urination is normal, healing occurs through the passage of blood.

The *Shanghan Li* (Examples of Cold Damage) states: For Shaoyin syndrome presenting with diarrhea and pus/blood in stool, Taohua Tang (Peach Kernel Decoction) is used to secure collapse, dispel cold, and tonify healthy qi.

Xu treated Shaoyin syndrome complicated by nasal bleeding and umbilical bleeding due to erroneous sweating, using Jiang Fu Tang (Ginger and Aconite Decoction) to address the root of Shaoyin disease.

The *Yin Zheng Lue Li* (Brief Principles of Yin Syndromes) records: Treating bleeding from the Three Jiao where the blood color is dark purple and dull indicates that severe damp-cold has transformed into toxin, causing coagulation and infiltration. Treatment requires Hei Xi Dan (Black Tin Pill) (see *Zhi Zhi Fang*).

Commentary: The syndromes discussed above are all variations of Cold pathogen diseases. There are even more severe cases, such as described in the text: after taking Guizhi Tang, if hematemesis occurs, it will likely progress to vomiting pus and blood. Additionally, in Jueyin Cold Damage, after severe purgation on the seventh day, if the Cun pulse is deep and slow, hands and feet are cold, the Chi pulse at the lower position is imperceptible, the throat is obstructed, there is expectoration of pus and blood, and uncontrollable diarrhea persists, this is difficult to treat and requires Mahuang Shengma Tang (Ephedra and Ascending Dragon Decoction). Fire pathogen also causes dry throat and bloody saliva; Yang Du (Yang Toxin) also causes hematemesis. These are extreme variations and cannot be compared to simple nasal bleeding syndromes. Generally speaking, accumulated blood and lower bleeding in Shanghan are complications of transmission. If lower bleeding occurs followed by cooling of the body, the disease resolves. If there is no transmission to the interior, and the pathogen cannot be dispersed, forcing blood to flow recklessly downward, this is an adverse sign. Profuse lower bleeding that cannot be stopped is considered difficult to treat.