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Cheng Wuji: In miscellaneous diseases, hematemesis (vomiting blood) and hemoptysis (coughing up blood) are generally attributed to excess pathogens. However, in Shanghan (Cold Damage), these symptoms result from erroneous use of sweating methods, purgative methods, and counteracting fire therapies. This is indeed not a mild manifestation of cold or heat diseases but constitutes a "Huai Bing" (complicated disease/deteriorated condition). Treatment should follow the regulation of qi reversal.

Only in the case of Shaoyin disease with Jue (cold extremities) exhaustion where sweating was erroneously induced, forcing the movement of channel blood, is it said to be difficult to treat. Those who take Guizhi Tang (Cinnamon Twig Decoction) and subsequently vomit will inevitably vomit pus and blood later (treatable with Huangqin Tang or Mahuang Shengma Tang). If the pulse is floating and heat is severe, but moxibustion is applied instead, it will inevitably cause dryness of the throat and spitting of blood (this is caused by fire pathogen forcing blood upward; treatable with Maohua Tang, Jiedu Tang, or Huangqin Shaoyao Tang). In Shaoyin disease, if there is only Jue (cold extremities) without sweat, forcing sweating will inevitably disturb the blood. Blood may exit from the mouth and nose or from the eyes. This is named "Xia Jue Shang Jie" (lower Jue and upper exhaustion) and is difficult to treat. In Shaoyin syndrome, if there is aversion to cold and fever but no headache, and erroneous heavy sweating causes blood to flow from the ears, eyes, mouth, and nose, it is named Yin blood depletion with muteness. This differs from Yang blood conditions such as epistaxis (nosebleed). After six or seven days of Shanghan, following severe purgation, if the cun pulse is deep and slow, hands and feet are cold, the lower pulses are imperceptible, the throat is obstructed, pus and blood are spat out, and diarrhea persists, it is difficult to treat (treatable with Mahuang Shengma Tang). For sore throat accompanied by hematemesis, if the face is red with mottled patterns like brocade, it is Yang Du (Yang Toxin), suitable for Shengma Biejia Tang.

Li Dongyuan: I treated a poor scholar suffering from Spleen and Stomach deficiency. After recovering with tonifying prescriptions, he moved into an empty room and slept on a heated kang. He coughed and vomited blood several times. I reasoned that due to long-term weakness, external cold had invaded while internal fire stagnated, leading to insufficient upper Qi and deficient exterior Yang. One should tonify the exterior Yang and clear the interior deficiency heat. Because he lived in an empty room in winter with thin clothing, his Yang was further depleted. Severe cold at the exterior blocked the interior, preventing the fire pathogen from dispersing, thus causing blood to exit from the mouth. This reminded me of Zhang Zhongjing's treatment of Shanghan with a floating-tight pulse. Had Mahuang Tang been used for sweating initially but was withheld, leading to Mai Ni (blood loss via nose), administering Mahuang Tang later cured him immediately. This case is very similar. Therefore, I prescribed Mahuang Renshen Shaoyao Tang.

Mahuang Renshen Shaoyao Tang Formula: Mahuang (1 qian, to expel exterior cold), Guizhi (0.5 qian, to tonify exterior deficiency), Baishao Yao (1 qian), Huangqi (1 qian, to solidify the exterior and benefit Wei Qi), Zhi Gancao (1 qian, to tonify the Spleen), Wuweizi (5 grains, to calm Lung Qi), Maimendong (3 fen, to protect Lung Qi), Renshen (3 fen, to benefit Sanjiao Yuan Qi deficiency and solidify the exterior), Danggui (0.5 qian, to harmonize and nourish blood). The above herbs are coarsely crushed. Take one dose. Add three zhan of water, boil Mahuang until boiling, skim off the foam, reduce to two zhan, add remaining herbs, boil until one zhan remains, strain, and take hot. Taking one dose before sleep results in cure. Observing this formula, it serves as a model for all generations. It essentially combines half of Zhang Zhongjing's Mahuang Tang with half of a tonifying prescription. Whenever a deficient constitution requires a Zhang Zhongjing formula, this should be the standard.

Zhu Danxi: In Shanghan, hematemesis occurs when pathogens affect the Yang channels. Initially, heat is at the exterior and should be released via sweating. If heat-toxin enters the channels and knots in the Five Zang organs, causing internal stasis, hematemesis results. For severe blood stasis, use Didang Tang. For mild cases, use Tao Ren Chengqi Tang combined with Xijiao Dihuang Tang and Sanhuang Wan.