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The Liver governs anger; anger injures the Liver. The Spleen governs thought; excessive thought injures the Spleen. This illness originates from emotional distress. Initially, it presented with fullness and oppression in the Upper Jiao (Upper Burner), belching, and hiccuping. This was caused by Liver Qi rebelling horizontally, obstructing the descending function of Stomach Qi. The physician failed to examine carefully and blindly administered Qi-breaking herbs such as Areca Seed (Binglang), Immature Bitter Orange (Zhishi), and Magnolia Bark (Houpo), which damaged Stomach Qi. Consequently, distending pain in the chest and epigastrium worsened, accompanied by nausea and a desire to vomit. Although wheat-based foods were tolerated, drinking even a little rice soup caused discomfort in the epigastrium. The condition persisted for three years, resembling dysphagia (difficulty swallowing) but not being true dysphagia. Despite trying every possible method, there was no effect. The *Yellow Emperor's Inner Classic* states: "In the Five Elements, the Liver corresponds to Wood, and its associated grain is Wheat." The inability to eat grains but ability to eat wheat is due to strong Liver Qi and weak Stomach Qi. Essentially, because Stomach Qi is weak, grains are difficult to digest; because Liver Qi is strong, wheat can be tolerated. The method of calming the Stomach and restraining the Liver should not be wrong. However, since this syndrome belongs to internal injury from emotions, it cannot rely solely on medicinal power. Zhang Jifeng considered this a disorder of the spirit and mind, suggesting introspection and quiet cultivation. The phrase "fleeing to Zen" (Tao Chan) is particularly exquisite. If cultivation is termed "fleeing," what must the state of mind be like?

An Bo comments: The method of calming the Stomach and restraining the Liver likely involves using Pinellia Tuber (Banxia), Tangerine Peel (Guangpi), stir-fried Lotus Leaf Peduncle (Chao Xiang He Ye Di), Poria (Fuling), and Rice Germ Husk (Chutou Kang) to calm the Stomach, while using Mume Fruit (Wumei), White Peony Root (Baishao), Green Calyx Plum Blossom (Lvemei), Butterfly Orchid Flower (Muhudie), Jujube (Zaor), and Areca Seed (Binglang) to restrain the Liver. It requires aromatic and cleansing herbs to clear the collaterals, ensuring the Qi mechanism is loose and agile without dullness, allowing the rebellious Qi to descend, thereby enabling the Yang of the Stomach to move freely.

The pulse is large and fails to gather, indicating Yang deficiency. The constitution is also prone to excessive mental and physical labor. The old ailments of wheezing and sweating were managed peacefully with decoctions and pills of warming and tonifying nature. A month ago, an accidental contraction of external pathogens caused coughing, followed by epistaxis (nosebleed) and blood-streaked sputum. Recently, vomiting blood has continued incessantly, accompanied by bitter taste in the mouth, reduced appetite, dizziness, and shortness of breath. Regarding ordinary hematemesis (vomiting blood), it is usually due to Fire in the Liver and Lungs. Medicines that clear and descend would extinguish the Fire, and the bleeding would stop naturally. However, the patient's essence and Qi are originally deficient. With the initial recovery of one Yang, both form and spirit are exhausted, and Water and Fire fail to interact. Qi follows Blood out of the body, and the disease concerns the root essence. Administering more clearing and descending medicines would damage Zhen Qi (True Qi), leading to the separation of Yin and Yang (death). The ancient sages said, "When seeing blood, do not treat the blood directly," a statement worthy of deep reflection. It is proposed to use Black Guipi Tang (Black Spleen-Nourishing Decoction) to nourish the Heart and Spleen, assisted by Shengmai San (Generate the Pulse Powder) to protect Metal (Lung) and grasp Kidney Qi. After taking three doses, the bleeding stopped, and the pulse gathered. The *Inner Classic* states: "At forty, Yin Qi naturally halves." Normally deficient in constitution and often ill, now having lost a large amount of blood, the source of life generation cannot continue. Visceral True Qi is consumed. Irrigation and cultivation (restoration) are especially difficult. Although Blood is generated by the Heart and stored in the Liver, it is actually controlled by the Spleen. Ancients treating blood disorders often achieved success with stomach-regulating medicines, which is indeed reasonable. Furthermore, the root of Phlegm is Water, originating from the Kidney; the movement of Phlegm is Dampness, arising from the Spleen. The *Neijing* refers to excessive Phlegm as white blood. Is this truly Phlegm, or is it Essence and Blood? Can there be something called Phlegm apart from Essence and Blood? Thus, the ancients also argued, "When seeing Phlegm, do not treat the Phlegm directly." Referencing Wuyin Jian (Five Yin Decoction), Water, Earth, and Metal represent the source of Qi transformation of the Pre-Heaven (Innate) One Qi.

An Bo comments: The rationale of the prescription is exquisitely profound. Treating hematemesis with the Guipi method is a very difficult task. Practitioners must investigate and determine the diagnosis accurately; otherwise, disaster will follow swiftly.