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Sweating (Diaphoresis), Vomiting (Emesis), Purging (Purgation), and Harmonizing (Harmonization) constitute the four major methods for treating miscellaneous diseases. However, in cases of hemorrhage, there are indications and contraindications. In Shanghan (Cold Damage) disease, excessive sweating damages the body fluids. In hematemesis (vomiting blood), both Yin-blood and water-jin (body fluids) are damaged, leading to a dual deficiency of water and blood, causing the body to wither like dry bones. Therefore, Zhang Zhongjing strictly forbids diaphoresis in patients with epistaxis (nosebleed). If epistaxis contraindicates sweating, then vomiting and hemoptysis (coughing up blood) certainly do as well.

When the pulse is deep and hidden, and Qi is latent, blood descends properly and does not ascend recklessly. Sweating causes Qi to dissipate outward. In patients with hematemesis, Qi is difficult to consolidate; if it continues to dissipate, blood will overflow following the ascending Qi, becoming uncontrollable. Thus, even if exterior symptoms are present, only harmonizing and dispersing methods should be used; one must not directly employ potent diaphoretics such as Ephedrae Herba (Mahuang), Cinnamon Twig (Guizhi), Notopterygii Rhizoma et Radix (Qianghuo), or Saussureae Radix (Duhuo).

If the hemorrhage is indeed caused by external pathogens, dispersion from the exterior may be considered, but it must combine dispersing with consolidating measures to prevent excessive sweating from depleting Yin. Only by understanding that hemorrhagic patients contraindicate sweating can one discuss methods to induce sweat. As for emesis, it is strictly prohibited. Patients with hemorrhage already have rebellious Qi; if phlegm-saliva is present and emesis is induced, this aids the rebellious trend, inevitably causing Qi to ascend without cessation.

The principle of treatment dictates that for upward-rebellious conditions, one must suppress them. By ensuring Qi does not rush upward, blood will not overflow. By descending Lung Qi, smoothing Stomach Qi, and anchoring Kidney Qi, Qi descends, and blood follows. Once bleeding stops, Qi also returns to calmness. Hemorrhagic patients most fear the disturbance of Qi. Not only is emesis contraindicated during illness, but even after recovery, if other miscellaneous syndromes arise, emetic drugs must not be used lightly. Often, emesis triggers hemorrhagic syndromes. Knowing that hemorrhage contraindicates emesis implies that descending Qi and stopping vomiting are methods for treating hemorrhage.

One might ask: Hemorrhagic syndromes are mostly deficient; since sweating and vomiting are inadvisable, purging should certainly be contraindicated. I say otherwise. Blood ascends because Qi surges and overflows. Hence, we contraindicate emesis and sweating to avoid agitating Qi further. Purging, however, is precisely the method to curb Qi. Eight or nine out of ten hemorrhagic cases involve excess Qi and flourishing Fire. When Qi surges uncontrollably, purging is appropriate to curb its momentum. Zhang Zhongjing’s Yangming syndrome protocols include "urgent purging to preserve Yin," and Shaoyin syndrome protocols also include "urgent purging to preserve Yin." In hemorrhagic cases with excessive Fire, the greatest fear is the loss of Yin; purging is exactly the means to save Yin. Purging here is tantamount to tonification.

However, purging must be timed correctly. If pathogenic factors remain long-term and Zheng Qi (Upright Qi) can no longer support, or if loose stools/diarrhea occur, purging has no place. In such cases, one should regulate slowly, using purely cooling, moistening, descending, and draining methods, adhering to the intent of purging without violating it. This constitutes proper technique.

Harmonizing is the premier method for treating hemorrhage. For exterior issues, it harmonizes Lung Qi; for interior issues, it harmonizes Liver Qi, while particularly attending to Spleen and Kidney Qi. It may tonify Yin to harmonize Yang, reduce Yang to harmonize Yin, expel stasis to harmonize Blood, drain water to harmonize Qi, combine tonification and purgation, or use cold and hot herbs mutually. The subtleties are numerous and cannot be fully enumerated.

Beyond these four methods lies tonification. Hemorrhage falls under the category of Deficiency Consumption (Xu Lao); discussion of tonification is inevitable. Even patients prefer talking about tonification, and medical texts emphasize tonification in eight or nine out of ten cases. Yet, one must know that tonification for hemorrhage also has indications and contraindications. Tonifying when pathogenic factors are unremoved is like "locking the door to chase away thieves"; tonifying when blood stasis remains is like "aiding thieves to cause disaster." Tonification of the Spleen applies to 30-40% of cases; tonification of the Kidney applies to 50-60%; tonification of Yang applies to 20-30%; tonification of Yin applies to 80-90%.

Ancient texts mention "tonifying Qi to control Blood," which applies to Qi collapse, not Qi rebellion. There is also the method of "guiding Fire back to its source," established for conditions of Cold Water and Floating Fire, not for Yin deficiency with Yang hyperactivity. Generally, if Fire has not erupted in hemorrhagic patients, tonifying the Middle Jiao leads to recovery. If Fire has erupted, cold-natured herbs suffice to destroy the vital energy of the Five Zang organs, while warm-tonifying herbs damage the True Yin of the two Kidneys. One should instead use sweet-cold herbs to nourish Yin and nurture Yang-Blood, returning them to their proper positions. The indications and contraindications for drug usage in hemorrhagic patients are generally as described above. Grasping these key principles allows for a firm grasp upon detailed study of the entire text.