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Xu Yuelin's daughter suffered from gingival bleeding (Chi Nu). After taking herbs such as Shengdi Huang (Rehmanniae Radix), Dan Pi (Moutan Cortex), Chi Shao Yao (Paeoniae Radix Rubra), Lian Qiao (Forsythiae Fructus), Shi Gao (Gypsum Fibrosum), and Sheng Ma (Cimicifugae Rhizoma), the bleeding worsened. I removed Sheng Ma from the prescription and added Xi Jiao (Rhinocerotis Cornu). The bleeding stopped after one dose. Mr. Xu asked, "Ancient texts mention using Xijiao Dihuang Tang for blood disorders; if Xi Jiao is unavailable, Sheng Ma is used as a substitute because it guides other herbs into the Yangming channel. Since Sheng Ma was ineffective here, are ancient prescriptions unreliable?" I replied, "Zhu Eryun stated: Sheng Ma has an ascending nature, while Xi Jiao has a descending nature. Using Xi Jiao to stop bleeding relies on its descending qi to clear Heart and Liver fire, causing blood to descend and return to its vessels. If Sheng Ma is mistakenly used, blood will follow the ascending qi and continue to gush uncontrollably. One cannot rigidly adhere to ancient prescriptions." Mr. Xu further asked, "There are many herbs that enter the Yangming channel to clear stomach heat. Why is only Xi Jiao suitable for gingival bleeding? Is it because teeth are located in the upper part, and horns grow on the head, following the principle that 'those originating from heaven are close to the upper'?" I answered, "It is not just that. The upper teeth belong to the Foot-Yangming Stomach Channel. The *Book of Rites* states that animals with horns do not have upper teeth. The meridians of Yangming connect upwards to the horns. Therefore, using Xi Jiao for gingival bleeding is often effective due to this correspondence."

An Bo commented: A physician who sticks to ancient prescriptions without adapting them is like a carpenter demolishing old materials to rebuild a foundation; although the structure may fit, mortise and tenon joints still require saws and chisels.

I resided in Yanzhen, about fifty li east of my ancestral home, Dongxi. In the spring of the Dinghai year, my clan brother Yi Cai suffered from hematemesis (vomiting blood). Recently, he had been treated by Yongtang, a student of my brother Chunpu. The bleeding continued unabated, and his condition became critical, nearly leading to syncope and collapse. His family sent a messenger overnight to summon me urgently. Upon arrival, I found the patient lying supine against the bed, breathing faintly. He reported that a sensation of hot qi rushing upward from below the umbilicus triggered the bleeding. His pulse was deficient, large, and unconsolidated. I said to my brother and the doctor, "This is a sign of failure of water and fire to interact." The *Classic of Acupuncture and Moxibustion* states: Water is Yin, Fire is Yang. In the human body, Yin and Yang embrace each other without separation, allowing for a long life. Thus, if Yang Qi tends to ascend and escape, Yin Qi attracts it from below, preventing escape. Now, Yang Qi ascends freely, but Yin fails to attract it downward, posing a crisis. The medications taken were all yin-nourishing and astringent agents, matching the syndrome. The reason they failed is that the disease was severe while the medication was too light." I prescribed a large dose of Liangyi Jian (Two-Primal Decoction) combined with Shengmai San (Generate the Pulse Powder), plus Guiban (Testudinis Carapax et Plastrum), Huainiuxi (Achyranthis Bidentatae Radix), Baishao (Paeoniae Radix Alba), Fuling (Poria), Shanyao (Dioscoreae Rhizoma), Tongbian (Urine of a Healthy Child), Ejiao (Asini Corii Colla), etc. After taking the medicine, the bleeding ceased, but the pulse remained unconsolidated. I said, "Be cautious; prevent recurrence of vomiting. This morning, due to relatives visiting and answering questions, fatigue caused the blood to surge again, and his spirit drifted, nearly collapsing. I hastily adjusted the original formula, increasing Shudi Huang (Rehmanniae Radix Preparata) from 1 qian to 2 qian, and added Cishi (Hematitum) to guide Kidney Qi back to its origin. Additionally, prepare softshell turtle soup to decoct the herbs. To treat the flight of True Yang, one must use creatures like turtles or softshell turtles to guide it down, otherwise, it cannot settle." Following this instruction, the bleeding stopped quickly. In the late afternoon, noise from family members caused the blood to overflow again, though less severely than before, making him feel unable to endure. Blood belongs to Yin and prefers stillness; movement transforms it into Yang, causing it to exit through the upper orifices. I instructed him to close the doors and avoid disturbances. After two days and nights of this, his pulse consolidated, his spirit calmed, and the bleeding stopped. He continued with the previous method for regulation and recovery, recovering fully after more than a month.

An Bo commented: Both the prescription and the theoretical discussion are exquisite.