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Hematemesis (vomiting blood), epistaxis (nosebleed), hematochezia (blood in stool), and hematuria (blood in urine) are all conditions where blood leaves the meridians. Any blood that has left the meridians is separated from and no longer harmonizes with the blood that nourishes the whole body. For blood that has already entered the stomach, it is permissible to let it be expelled through vomiting or defecation. For blood remaining within the meridians but not yet entering the stomach, medication should be urgently administered to eliminate it. It should either be excreted via urination or via defecation, ensuring nothing remains, so that no residual pathogenic factors cause further harm. Blood retained in the body cannot merge with healthy blood but instead obstructs the mechanism of new blood formation. Therefore, in all blood disorders, removing blood stasis is paramount. The common belief that only blood clumps constitute stasis, while clear blood does not; or that dark blood is stasis while fresh blood is not, is inaccurate. When blood first leaves the meridians, although it may appear clear and bright red, since it has left the meridians, even clear or fresh blood constitutes blood stasis. After staying outside the meridians for a long time, the blood turns purple-black. For instance, when skin is struck by a stick, the initial injury shows redness and swelling; thus, blood just leaving the meridians is still fresh. After a few days, the color changes to blue-black; thus, after a long time outside the meridians, the blood becomes purple-black. This blood within the meridians, though purple-black, remains fluid and is not a solidified blood clot. Therefore, it can circulate with Qi, enter the intestines and stomach, and be expelled through vomiting or defecation. If it were a solidified clot within the meridians, how could it enter the intestines? As for blood clots, they form when blood enters the intestines and stomach, stays for a moment, and immediately coagulates. Observing blood dripping into a basin during the slaughter of pigs or sheep, which coagulates instantly, confirms this. Thus, in cases of hematemesis or epistaxis, regardless of whether the blood is clear, clotted, fresh, or dark, removing blood stasis must be the priority. Moreover, where there is blood stasis, there are symptoms of blood stasis. Physicians should treat according to these symptoms without fear of adverse effects from expelling stasis.

When blood stasis attacks the Heart, symptoms include heart pain, dizziness, coma, and loss of consciousness. Whether in postpartum women or patients with hematemesis/epistaxis, these symptoms indicate a critical condition. Urgent treatment is required to descend the stasis and protect the Heart. Use Guixiong Shixiao San (Cinnamon Twig and Ligusticum Decoction with Five-Step Powder) added with Amber (Hupo), Cinnabar (Zhusha), and Musk (Shexiang). Alternatively, using Guixiong Tang (Cinnamon Twig and Ligusticum Decoction) to administer powders of Dragon's Blood (Xuexie) and Frankincense (Ruxiang) is also effective.

When blood stasis invades the Lung, symptoms include coughing with reversed Qi, panting, blackening around the nostrils like soot, and blackening of the mouth and eyes. Use Shen Su Yin (Ginseng and Perilla Drink) to tonify the Lung and remove stasis. These are all critical conditions. Sudden death from hematemesis is often due to blood stasis invading the Lung and blocking the airway. For patients with Lung Qi deficiency causing shortness of breath, this formula is most stable. For those with excess Lung Qi and obstruction, do not tonify the Lung; simply remove the stasis to unblock the Qi, and survival is possible. Use Tingli Dazao Tang (Descurainia Seed and Jujube Decoction) added with Suxmu (Sappan Wood), Puhuang (Pollen Typhae), Wulingzhi (Trogopterus Dung), and child's urine.

When blood stasis exists between the meridians and Zang-Fu organs, it causes pain throughout the body because it blocks the flow of Qi, leading to stagnation and pain. This is what is meant by "pain indicates obstruction." Use Foshou San (Buddha's Hand Powder) added with Taoren (Peach Kernel), Honghua (Safflower), Xuexie (Dragon's Blood), Xuduan (Dipsacus Root), Qinjiao (Gentiana Macrophylla), Chaihu (Bupleurum), Zhuru (Bamboo Shavings), and Gancao (Licorice), guided by wine. Or use Xiaochai Hu Tang (Minor Bupleurum Decoction) added with Danggui (Angelica Sinensis), Baishao (White Peony Root), Danpi (Moutan Bark), Taoren (Peach Kernel), and Jingjie (Schizonepeta), which is a general formula for internal and external stasis, offering a more balanced approach.

When blood stasis is in the Upper Jiao, it may cause hair loss, hardness and stabbing pain in the bones, arms, chest, and diaphragm, and blurred vision. Use Tongqiao Huoxue Tang (Orifice-Unblocking Blood-Invigorating Decoction). Xiaochai Hu Tang (Minor Bupleurum Decoction) added with Danggui (Angelica Sinensis), Baishao (White Peony Root), Taoren (Peach Kernel), Honghua (Safflower), and Daji (Great Thistle) also treats this.

When blood stasis is in the Middle Jiao, it causes abdominal pain, hypochondriac pain, and fixed stabbing pain in the waist and umbilical region. Use Xuefu Zhuyu Tang (Blood Mansion Stasis-Expelling Decoction). Xiaochai Hu Tang (Minor Bupleurum Decoction) added with Xiangfu (Cyperus Rhizome), Jianghuang (Turmeric Rhizome), Taoren (Peach Kernel), and Dahuang (Rhubarb Root) also treats this.

When blood stasis is in the Lower Jiao, it causes distension and stabbing pain in the lateral hypochondrium and lower abdomen, and black stools. Use Shixiao San (Five-Step Powder) added with Vinegar-processed Junjun (Da Huang/Rhubarb) and Taoren (Peach Kernel). Gexia Zhuyu Tang (Diaphragm Below Stasis-Expelling Decoction) is also stable.

When blood stasis is deep inside (in the interior), it causes thirst. This is because Blood and Qi are inseparable; internal blood stasis prevents Qi from circulating freely, so Qi cannot carry fluids upward, resulting in thirst, termed "Blood Thirst." Once the stasis is removed, the thirst ceases. Use Siwu Tang (Four Substances Decoction) added with Zaoren (Ziziphus Seed), Danpi (Moutan Bark), Puhuang (Pollen Typhae), Sanqi (Notoginseng Root), Huafen (Trichosanthes Root), Yunling (Poria), Zhike (Aurantii Fructus), and Gancao (Licorice). Xiaochai Hu Tang (Minor Bupleurum Decoction) added with Taoren (Peach Kernel), Danpi (Moutan Bark), and Niuxi (Achyranthes Root) also treats this. Wenjing Tang (Warming Meridian Decoction) uses warm herbs to remove stasis and is suitable for chronic stasis. These formulas should be used judiciously.

When blood stasis is in the Couli (interstices of skin and muscle), it disrupts Ying and Wei harmony, causing fever and aversion to cold. The Couli lies between the exterior and interior, serving as the pathway for Qi and Blood circulation. Stasis here damages Ying Qi, causing aversion to cold, and damages Wei Qi, causing heat intolerance. Thus, alternating chills and fever resembling malaria occur. Use Xiaochai Hu Tang (Minor Bupleurum Decoction) added with Taoren (Peach Kernel), Honghua (Safflower), Danggui (Angelica Sinensis), and Jingjie (Schizonepeta).

When blood stasis is in the Muscle, it causes mild fever, spontaneous sweating, and night sweats. Muscles are governed by the Yangming channel. Due to the dryness of Yangming, stasis steams and郁 (constrains), presenting symptoms similar to Baihu Tang syndrome (high fever, profuse sweating). Use Xigui Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Taoren (Peach Kernel) and Honghua (Safflower). Xuefu Zhuyu Tang (Blood Mansion Stasis-Expelling Decoction) added with vinegar-fried Dahuang (Rhubarb Root) also treats this.

When blood stasis is between the meridians and Zang-Fu organs, it forms Jia masses (mobile abdominal masses). Jia masses may gather or disperse. When Qi is blocked by blood, it gathers into a shape; when blood disperses with Qi, it disappears. When newly gathered, resolve the blood stasis by moving Qi. Use Jiuqi Wan (Nine Qi Pill). If located in the upper chest/diaphragm, add Jiegeng (Platycodon Root), Zhike (Aurantii Fructus), Gualou (Trichosanthes Fruit), Shengjiang (Fresh Ginger), and Gancao (Licorice). If on the right, add Suzi (Perilla Seed), Sangpi (Mulberry Bark), and Chenpi (Tangerine Peel). If on the left, add Qingpi (Green Tangerine Peel), Muli (Oyster Shell), and Danggui (Angelica Sinensis). In the middle/large abdomen, add Houpo (Magnolia Bark), Zhike (Aurantii Fructus), Fangji (Stephania Root), Baishao (White Peony Root), and Gancao (Licorice). In the lower abdomen, add Juhe (Tangerine Seed), Xiaohui (Fennel Seed), Lihé (Lychee Seed), Binglang (Areca Nut), Chuanlizi (Toosendan Fruit), and Wulingzhi (Trogopterus Dung). When Qi moves, blood follows and disperses, preventing accumulation. After dispersion, fear of re-accumulation arises; thus, harmonize Qi by regulating Blood. At this stage, with Qi dispersed and residing in the Blood aspect, regulating Blood naturally harmonizes Qi and prevents re-gathering. Use Xiaoyao San (Free and Easy Wanderer Powder) added with Danpi (Moutan Bark) and Xiangfu (Cyperus Rhizome). Guipi Tang (Restore the Spleen Decoction) added with Chaihu (Bupleurum), Yuzi (Curcuma Aromatica Rhizome), and Lingzhi (Ganoderma Spore - *Note: Text says 'Lingzi', likely referring to a specific herb or typo, interpreted contextually*) also treats this. Zheng masses (fixed abdominal masses) often persist because Blood is abundant and Qi is deficient, so Qi cannot overcome Blood to disperse them. They may be pure blood quality, or blood wrapping water, or old blood transforming into phlegm-water. Water is a form of Qi. Zheng diseases result from the gumming together of Qi and Blood. One must break Blood and move Qi to push them out. These are major evils, tolerable neither. Even in deficient patients with long-standing accumulations unsuitable for direct attack, combine attacking and tonifying to defeat the enemy. To attack blood quality, use Didang Tang (Definite Victory Decoction), Xiayuxue Tang (Lower Abdomen Blood-Stasis Expelling Decoction), or Dai Didang Wan (Substitute Definite Victory Pill). To attack phlegm-water, use Shizao Tang (Ten Date Decoction). For simultaneous water and blood attack, use Dahuang Gansui Tang (Rhubarb and Kansui Decoction) or the secret formula Huaqi Wan (Qi-Transforming Pill). External treatment: apply Guanyin Jiuku Gao (Guanyin Saving from Suffering Plaster).

When blood stasis between meridians and Zang-Fu fights with Qi, it steams, rots, and transforms into pus. See sections on vomiting pus, bloody stool, and sores for details; not repeated here.

When blood stasis between meridians and Zang-Fu is boiled by Qi and Fire, it becomes Dry Blood. Qi refers to Kidney Yang. Yin deficiency with Yang hyperactivity causes Qi to merge with Heart Fire, so excessive Qi means excessive Fire. Stagnant blood, scorched by Fire, becomes Dry Blood. Symptoms include bone-steaming tidal fever, crusty skin (keratosis pilaris-like), and flaky face, named Dry Blood Lao (Consumption). Cases reaching this stage have only a 20-30% cure rate. Zhang Zhongjing's Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) treats this. Since Dry Blood is cut off from Qi transformation, ordinary blood-invigorating herbs cannot treat it. Thus, insect medicines that feed on blood are used to consume the Dry Blood. If stasis is not removed, new blood has no life source; if Dry Blood is not removed, new blood certainly has no hope. Therefore, despite various deficiencies appearing, the primary goal is removing Dry Blood. If courage is lacking, this pill can be taken with tonifying medicines as a compromise.

When blood stasis between meridians and Zang-Fu is changed by Wind and Qi, Labo Worms (TB parasites) are generated. Qi is transformed from Kidney Water; thus, Qi movement generates Dampness. Wind is generated from Liver Yang; thus, Wind movement generates Heat. Damp steaming and Heat fanning transform blood stasis into worms, called Labo Worms. This is like grass rotting into fireflies or grain flying into insects. Differentiation includes: complexion changing suddenly from red to white, green to yellow; sores on lips and mouth; hoarse voice and itchy throat; irritability, restless dreams, nocturnal emission and leukorrhea; brittle hair and dry tongue; chills, fever, and night sweats; foul breath, loss of smell; liking to see others' faults; frequent anger; dreaming of deceased ancestors; palpitations and coughing; abdominal masses; small nodules on both sides of the back of the head; smelling beans as fragrant; applying frankincense smoke to the back of the hand and covering the palm with a cloth, causing hair to grow an inch long within moments; good spirit at dawn but slight limb fever, pale face after noon. These are signs of Labo Worms. Yuehua Wan is the main treatment. Eating eel meat provides tonification and kills Labo Worms. Alternatively, burn eel bones to charcoal, stir-fry turtle shell to powder, and take with Renshen (Ginseng), Danggui (Angelica Sinensis), Baishao (White Peony Root), and Baiwei (Anemarrhenae Rhizome) decoction. Tonify deficiency and kill worms synergistically. For specific worm-killing, Jinchan Wan (Golden Toad Pill) can be taken intermittently. Burning and consuming golden-line frog is also excellent. Killing a black cat, taking its liver, drying it, and taking the powder at dawn on an empty stomach in the early morning of the first lunar day greatly kills Labo Worms, replacing otter liver. Otter claws powdered and taken with wine also treat worms residing between lung lobes causing hemoptysis and hoarseness.

Labo Worms are worms transformed from blood, highly spiritual. After the person dies, the worms become evil spirits, infecting family members, becoming Transmitted Corpse Lao (Consumption). If three people are killed, the worm is incurable. Transmitted Corpse symptoms are identical to the infected patient's. Jinjian suggests taking Chuanshi Jiangjun Wan (Transmitted Corpse General Pill), recorded in Danxi Xinfa. However, checking Danxi Xinfa reveals this formula is absent. Naming it "General" implies Rhubarb is the main ingredient. Since Transmitted Corpse worms invade the body, they must be removed urgently. Thus, purgation is key, similar to Zhongjing's method for Dry Blood, to avoid leaving pathogens.

Once this worm enters the body, it gathers body blood to form nests, feeding, resting, reproducing, and changing endlessly. I suggest using Yishi Mieguai Tang (Corpse-Transferring Monster-Eliminating Decoction) to kill the worm and deprive it of blood, eliminating residual pathogens.

For the above two conditions, if stool is not loose, attack treatment is possible. If loose, the patient cannot tolerate medicine, and death is inevitable.