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[Wan] Qi belongs to Yang, Blood belongs to Yin; Yang governs movement, and Yin governs stillness. The blood in the human body must not move recklessly. The Classics state: When the Yang collaterals (collateral vessels distributed on the exterior and upper parts of the body) are injured, blood overflows externally, resulting in epistaxis (nosebleed); when the Yin collaterals (collateral vessels distributed internally and in the lower parts) are injured, blood overflows internally, resulting in hematochezia (blood in stool). Currently, the fire from the pox-rash scorches within, forcing blood to move recklessly, and blood moves along with the fire. If Yang collaterals are injured, blood exits from the Upper Jiao, manifesting as either epistaxis or hematemesis (vomiting blood). If Yin collaterals are injured, blood exits from the Lower Jiao, manifesting as either hematuria (blood in urine) or hematochezia. If both Yin and Yang collaterals are injured, blood exits from both above and below. Among all types of hemorrhage, only those bleeding from the nose may have a chance of being treated; the rest are death syndromes. There are also cases where pockmarks ulcerate and cannot scab or contract, with continuous bleeding; this is hemorrhage from Yang sores, which is also incurable.

[Zhang] What is said about blood moving recklessly—exiting from the mouth, large or small intestines, Yang sores, or due to pox toxins—are all considered incurable, referring specifically to cases where bleeding is profuse and does not stop. However, if at the initial onset, one carefully deduces the cause and manages it properly, how could there be no survivors? If pockmarks are red and painful, accompanied by vexation, heat, thirst, hematochezia, or epistaxis, first use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) for hemorrhage. Then use Jiajian Dazicao San (Modified Great Arneia Powder) for grayish-white pocks, removing Huanglian (Coptis Rhizome) and adding Mutong (Akebia Caulis). Wu treats various hemorrhages by consistently using Xijiao Dihuang Tang plus Zhizi (Gardeniae Fructus), Huangqin (Scutellariae Radix), Lianzi (Nelumbinis Semen - *Note: Context implies Lianzi or similar clearing herb, but text says Lianzi/Lianzi usually refers to Lotus Seed, however in context of clearing heat often implies Huanglian or similar, sticking to literal translation of characters provided*), Baishaoyao (Paeoniae Radix Alba). There are cases where epistaxis at the beginning did not stop but responded to purgatives.

[Xue] A child after having pocks presented with either epistaxis or hematochezia. The pock scars were irregularly red and white, and the fingers alternated between cold and hot. I stated this was due to deficiency of Yuan Qi (Original Qi) and rootless fire coming and going suddenly. In the morning, administer Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); in the evening, administer Wuyi Yigong San (Five-Ingredient Powder for Extraordinary Merit). After taking more than twenty doses of each, the child recovered. Later, due to mental exertion, the condition recurred. Still using the previous two formulas as the main treatment, supplemented with Shiquan Dabu Tang (Ten Complete Tonifying Decoction), the child recovered.

Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction): Indicated for pocks-rashes and measles accompanied by epistaxis or hematochezia.
Mudanpi (Moutan Cortex), Xijiao (Rhinoceros Cornu), Chishaoyao (Red Paeonia Root), Shengdihuang (Raw Rehmannia Root).
For excessive heat, add Jiu Chao Huanglian (Wine-fried Coptis Rhizome). If there is stagnant blood in the chest, add Cu Zhi Dahuang (Vinegar-processed Rheum Rhizome). For oral or nasal bleeding, add Daji (Great Thistle Root) and Maogen (Imperata Rhizome). For hematuria, remove Dahuang and add Xiaojì (Herba Hieracii Japonici). Decoct in water and take warm.

Erbao San (Two-Treasure Powder): Indicated for purple pocks, fever, epistaxis, hematuria, thirst, and delirious speech.
Xijiao (Rhinoceros Cornu), Dai Mao (Trionyx Carapax).
Grind these two ingredients into juice and take in one dose; recovery will follow immediately.

[Epistaxis and Hematemesis]
[Xue] The "Pox-Rash Formula" states: At the time of pock eruption, it is appropriate for them to appear slightly, similar in principle to sweating. Although blood and sweat differ, their source is one. Pocks-rashes arise from turbid blood; pathogens knot in the Lung and Stomach, and toxic vapors naturally ascend. If this syndrome appears, do not blindly administer medicine, lest improper treatment prevent expelled stagnation from exiting and damage what has already exited, causing complications. If there is thirst for cold drinks and heat in hands and feet, this indicates blazing toxic vapors and overflowing blood; use Xijiao Dihuang Tang from the "Shengji Zonglu". If epistaxis is due to Lung Meridian heat-toxin, use Dihuang Qingfei Yin (Rehmannia Lung-Clearing Drink). If hematemesis is due to Stomach Meridian heat-toxin, also use Xijiao Dihuang Tang from the "Shengji Zonglu". If hematochezia is due to Intestine/Stomach heat-toxin, also use this formula. If thirst is for hot drinks and hands/feet are not hot, this is Spleen and Lung Qi deficiency failing to control blood, causing reckless movement; use Wuyi Yigong San. If bleeding is accompanied by thirst, vexation, and ruddy complexion, this is Blood depletion; use Danggui Buxue Tang (Angelica Tonify Blood Decoction).
One child had epistaxis with a rapid Cun pulse. This indicated Fire in Metal of the Lung. Use Xiebai San (Drain White Powder) to stop bleeding, but since limbs were listless, use Yiqi Tang (Qi-Augmenting Decoction) to recover.
One child had red pocks, hematemesis, and fever. This was Stomach Meridian heat-toxin. First use Xijiao Dihuang Tang from the "Shengji Zonglu"; as symptoms gradually improved, then use Wuyi Yigong San for cure.

[Wan] Fever and hemorrhage from pocks-rashes are not favorable signs. However, bleeding from the nose indicates Fire punishing the Lung; the nose is the opening of the Lung. It is suitable to drain fire, cool blood, and clear the Lung. Use Xuanshen Dihuang Tang (Scrophularia and Rehmannia Decoction) mixed with Yujin powder (Curcuma Rhizome), added with Maogen juice (Imperata Rhizome juice) and Jingmo juice (Beijing Ink stick juice) to drink. If epistaxis stops, it is good; if it continues indefinitely, it is incurable.

Xuanshen Dihuang Tang (Scrophularia and Rehmannia Decoction)
Xuanshen (Scrophulariae Radix), Shengdihuang (Raw Rehmannia Root), Mudanpi (Moutan Cortex), Zhiziren (Gardeniae Fructus) (each 1.5 qian), Gancao (Licorice Root), Shengma (Cimicifugae Rhizoma) (each 0.5 qian), Baishaoyao (White Peony Root) (1 qian).
Chop finely. Add Ban Chao Puhuang (Half qian of fried Typha Pollen), one cup of water, decoct to 70%, remove dregs, and take warm.

Zhan Guan San (Pass-the-Gate Powder): Indicated for purple pocks with fever and unceasing nasal bleeding.
Shengdihuang (Raw Rehmannia Root), Mudanpi (Moutan Cortex), Huangqin (Scutellariae Radix) (each 0.5 fen), Shengma (Cimicifugae Rhizoma) (0.3 fen), Ou jie (Lotus Rhizome Node), Maogen (Imperata Rhizome) (each 1 qian), Lüdou (Mung Bean) (49 grains).
Decoct in water and take.

[Hematochezia]
For children with blood in stool during pocks, observe the nature of the blood and the timing. If pocks are vigorous and stool has not passed for several days, with blood coming out with feces, this is injury to the anal region causing bleeding. If pocks have retracted and stool contains pus and blood, this is blood from Dao Ye (internal collapse/retraction of pocks). Apart from these two categories, any hematuria or hematochezia indicates deterioration of Zang-Fu organs and reckless movement of Yin blood, which is a fatal sign.

[Xue] Wenren stated: If pocks result in blood in stool or black stools, and the patient sleeps without waking, this is an ominous sign indicating excessive internal heat. Use Xijiao Dihuang Tang, Baolong Wan (Dragon-Holding Pill), and Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Shengdihuang. I privately believe that for the aforementioned symptoms, if there are alternating chills and fever with thirst, use Xiao Chaihu Tang plus Shengdihuang. If there is fever with fatigue, use Wuyi Yigong San plus Danggui (Angelica Sinensis). If there is dry mouth and thirst, use Renshen Baizhu San (Ginseng and Atractylodes Macrocephala Powder). Generally, thirst with desire to drink and fever indicates Excess Heat; thirst for hot drinks without heat in hands/feet indicates Deficiency Heat; cold extremities indicate Deficiency Cold. Physicians must examine carefully.
One child had pocks with bleeding and failure to erupt. My father attributed this to insufficiency of Qi and Blood. Use Zicao Kuaiban Tang (Arneia Rapid-Eruption Decoction) plus Renshen (Ginseng), Fuling (Poria), Danggui (Angelica), Baizhu (Atractylodes). Bleeding stopped instantly, pocks erupted instantly, and Shizhen Tang (Eight Treasures Decoction) led to recovery.
One child had pocks with bleeding, red urine, pocks color like ochre, fever, desire for cold drinks, and difficulty in urination and defecation. My father attributed this to Excess Heat in Heart and Small Intestine. Use Bazheng San (Eight-Ingredient Powder for Rectification), followed by Jiedu Fangfeng Tang (Detoxifying and Saposhnikovia Decoction) and drinking Celery Juice for recovery.
One child had pocks nearing resolution but developed hematochezia, pale face, aversion to cold, and inability to pass stool despite urge. I attributed this to deficiency of Yuan Qi sinking downward. Use Yiqi Tang. The family did not believe me, administered cooling-blood agents, leading to vomiting, diarrhea, abdominal pain, and death.
One child had pocks nearing resolution but developed hematochezia, pale face, aversion to cold, cold hands and feet, and deep, fine pulse almost imperceptible. I attributed this to Yang Qi deficiency and cold, intending to use Renshen (Ginseng), Jiang (Ginger), Gui (Cinnamon Bark). The family refused. The next day the child died, with blue-black hands and feet. Alas.
One child had pocks for three to four days with a few drops of blood in stool daily, unable to erupt by the eighth day. Imperial Physician Qian Chunlin attributed this to Spleen Qi deficiency and cold. Use Muxiang San (Costus Powder) for two doses, plus 11 Dingxiang (Caryophylli Flos) and 5 qian Renshen (Ginseng). The next day pocks erupted with pus, bleeding stopped, and recovery occurred after twenty-plus days.

[Hematuria]
[Yuan] Hematuria appearing two to three days after pocks onset is named Qinsha Hong (Soaking Sand Red). This is because fierce toxins gather in the Heart, the Heart loses its mastery, and blood follows the toxin agitation, running wildly. The Heart connects to the Small Intestine, pouring into the Bladder causing hematuria. Urine may look like black bean juice or sappan wood water. If painful, it is easy to treat; if painless, difficult.

Main Formula
Mutong (Akebia Caulis), Shengdihuang (Raw Rehmannia Root), Huangqi (Astragali Radix), Chishaoyao (Red Paeonia Root), Xijiao (Rhinoceros Cornu), Diyu (Sanguisorbae Radix), Shengma (Cimicifugae Rhizoma), Zicao (Arnebiae Radix et Rhizoma), Cheqianye (Plantaginis Leaf) (use heavily), Dengcao (Junci Medulla).
Decoct in water. If painful, add Gancaosao (Licorice Root Tip), Huashi (Talcum), Zhizi (Gardeniae Fructus).

My treatment of this pock type focuses on clearing the Heart and resolving toxins, ensuring Yin blood returns to the Ying (Nutrient) level. Shengma and Huangqi should be used only after careful examination; do not rigidly adhere to a formula to harm people. If urine resembles black bean juice, toxins have rushed to the Heart and Ying origin has departed; eight or nine out of ten die. If there is urinary obstruction with blood clots like cotton threads an inch long, crying upon attempting to urinate, unbearable pain, urgently use Chao Zhizi powder (Fried Gardeniae Fructus) mixed with Qinglongxu Cao juice (Equisetum Hiemale Juice) to take, followed by Mutong Tang (Akebia Caulis Decoction).

[Anal Fissure Bleeding]
[Xue] Wenren stated: Constipation with pocks, urine like blood, abscess formation, or ruptured body pocks indicate blazing internal fire neglected by lack of resolution and drainage. Urgently use Xijiao Dihuang Tang, Xiao Chaihu Tang plus Shengdihuang, or Sishun Yin (Four-Smooth Drink). I privately believe: If Heart and Spleen heat is excessive, use Xijiao Dihuang Tang. If Heart and Liver heat is excessive, use Xiao Chaihu Tang plus Shengdihuang. If constipated, first use Sishun Yin, then Xijiao Tang. If bitter taste, red tongue, pain, and blockage of both bowels and urine, urgently use Liming Yin (Life-Saving Drink) plus Xiaofen (Mirabilite) and Dahuang (Rhubarb). If red tongue, pain, aversion to cold and fever, use Liming Yin plus Mahuang (Ephedra Herba). If caused by nursing mother's anger-fire, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Jiawei Guipi Tang (Modified Restore the Spleen Decoction).