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Bleeding from the ears can be stopped immediately by blowing calcined Longgu (Fossilia Ossis Mastodi, Dragon Bone) powder into the nasal cavity. If the pulse at the left Guan position is wiry and surging, use Chaihu Qinggan San (Bupleurum Liver-Clearing Powder). If the Chi pulse is either restless or weak, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).

Bleeding from the mouth and nose is all related to excess in the upper jiao and deficiency in the lower jiao, with qi ascending without descending, causing blood to follow the qi upward and escape through the upper orifices. The treatment principle should be to smooth the qi; when qi descends, blood returns to its vessels. It is appropriate to use Suzi Jiangqi Tang (Perilla Seed Qi-Descending Decoction), adding Renshen (Ginseng Radix) and Ejiao (Donkey-hide Gelatin) each at one qian, along with Xiayangzheng Dan (Lower-Nourishing Uprightness Pill). There are also cases where qi deficiency fails to control the blood; the pulse will necessarily be weak, thready, and soft, with mental fatigue. In such cases, Dushen Tang (Single Ginseng Decoction), or Renshen Yinzi (Ginseng Drink), or Tuanshen Wan (Round Ginseng Pill) are appropriate. For hematemesis caused by heat congestion in the upper diaphragm, with a pulse that is surging, large, wiry, and long, forceful upon pressure, unweary spirit, or a sensation of fullness and pain in the chest, or purple-black clots in the blood, use Shengdihuang (Rehmanniae Radix), Chishao (Paeoniae Radix Rubra), Danggui (Angelicae Sinensis Radix), Mudanpi (Moutan Cortex), Jingjie (Schizonepetae Spica), Ejiao, Huashi (Talcum), Dahuang (Rhei Radix et Rhizoma), Xuanmingfen (Natrii Sulfas Exsiccatus), and Taoren Ni (Persic Semen Paste), etc., to guide the blood out through the bowels. This is the method of "removing firewood from under the cauldron." Blood exiting from below is a favorable sign (Shun), while bleeding from above is unfavorable (Ni). For all conditions of blood overflowing upward, unless the patient has spleen deficiency with diarrhea and extreme emaciation unable to tolerate purgation, one should use vinegar-processed Dahuang, mixed with Shengdihuang juice, as well as Taoren Ni, Mudanpi, etc., to enter the blood level, causing the blood to descend and turning the unfavorable condition into a favorable one. This is a subtle method. Those who do not understand this but daily engage in using Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhizi (Gardeniae Fructus), and Huangbai (Phellodendri Cortex), assisting Siwu Tang (Four Substances Decoction), will damage both qi and blood, leading to the failure of the spleen and stomach. How can there be any survivors among those treated by physicians today for blood disorders? After the blood has descended, use Yiyiren (Coicis Semen) (use in large amounts), Baihe (Lilii Bulbus), Maimendong (Ophiopogonis Radix), and Xian Digupi (Fresh Lycii Cortex). Add Pipaye (Loquat Leaf), Wuweizi (Schisandrae Fructus), and Sangbaipipi (Mori Cortex) for cough and thirst. Add Beimu (Fritillariae Bulbus) for phlegm. These herbs have thin qi and light taste, being the fundamental medicines of the West Metal element. By reducing pathogenic factors according to their decline, recurrence will naturally cease; this is especially suitable for Xu Lao (Consumption) syndromes. To stop bleeding urgently, use two qian of Xueyu Hui (Ash of Human Hair), dissolve two qian of Ejiao in plain water, add one cup each of Tongbian (Infant Urine), Sheng Ou Zhi (Fresh Lotus Rhizome Juice), Ciji Zhi (Sonchii Juice), and Shengdihuang juice. Grind high-quality ink into a thick black liquid, mix well, and take warm in one dose. For irritability in the chest, continuous hematemesis, dryness of the mouth and tongue, and headache, use Shigao San (Gypsum Powder). For blood溢 (overflowing) due to rain exposure and dampness stagnating in the meridians, manifesting as epistaxis, note that epistaxis travels through the clear pathways, while hematemesis travels through the turbid pathways. If blood flows into the stomach, it causes hematemesis. Use Shen Zhuo Tang (Kidney-Dampness Decoction); add Chuanxiong (Ligustici Chuanxiong Rhizoma) for headache. This is most effective for stopping epistaxis occurring in bathrooms. For hematemesis in summer, where the patient has thirst, greasy face, dizziness, and dry retching, decoct Maodeng Xin Maimendong Tang (Equisetum, Centella, and Ophiopogon Decoction), adding Ou Jie Zhi (Lotus Node Juice), Ce Bai Ye Zhi (Platycladi Cacumen Juice), Mao Gen Zhi (Imperatae Rhizoma Juice), a little Shengjiang (Zingiberis Rhizoma Recens) juice, and a little Sheng Mi (Raw Honey). Mix with Wuling San (Five-Ingredient Powder with Poria). After bleeding stops, use Shengdihuang, Danggui, Mudanpi, Chishao Yao (Paeoniae Radix Rubra), and Baicao Shuang Mo (Powder of Hundred Herbs Ash), decocted and taken for one or two doses, then regulate with Liuyi Tang (Honeydew Melon and Talcum Powder). For liver injury due to anger, presenting with cyanotic lips and dark face, use Jisu Wan (Elsholtzia Pill), swallowed with Siwu Tang decoction, and also with Shisi You Wan (Fourteen Friends Pill) and Dengxin Maimendong Tang (Juncus and Ophiopogon Decoction), as they contain herbs that regulate the liver. For hematemesis due to bruising and trauma, first stop bleeding with Ou Jie Zhi, Ce Bai Ye Zhi, Mao Gen Zhi, Jiu Zhi (Leek Juice), Tongbian mixed with ink juice, and dissolved Ejiao. Then decoct Chuanxiong, Danggui, Baishao Yao (Paeoniae Radix Alba), Baihe, Jingjie Sui (Schizonepetae Spica), Ejiao, Mudanpi, Zijin Teng (Akebia Caulis), Dahuang, Huashi, and Honghua (Carthami Flos) in water, and take with Fan Jiangxiang Mo (Sappan Wood Powder) and Baiji Mo (Bletillae Rhizoma Powder). Dai Fu'an first used Suhexiang Wan (Styrax Pill), then treated with Heishen San (Black Divine Powder) and Xiao Wuchen Tang (Minor Dark Stagnation Decoction), regulated with Tongbian. For heart labor-induced hematemesis, use fifty Lianxin (Nelumbinis Plumula) and fifty Nuomi (Glutinous Rice), grind into powder, and take with warm wine, along with Tianmendong Tang (Asparagi Decoction). For excessive physical labor causing continuous hematemesis, use Suzi Jiangqi Tang added with Renshen and Ejiao; eat cooked pork liver dipped in Baiji powder. For chronic hematemesis that does not stop, use Songhua San (Pine Pollen Powder) and Baihua Jian (Hundred Flowers Decoction), and frequently take Da Ejiao Wan (Large Donkey-hide Gelatin Pill). If ineffective, use two qian of Fulonggan (Ustulatum Cao), taken with rice drink, to stop bleeding quickly. Or, after drinking alcohol or during stifling vomiting, if blood appears after vomiting, or if hematemesis results from consuming spicy and hot foods, it is named Fei Ju (Lung Abscess). Use Daji San (Greater Thistle Powder). Ancient formulas use Hongzao (Jujubae Fructus) charred to retain its nature, mixed equally with Baiyaojian (Fermented Medicated Leaven), ground into powder, and taken with rice drink at two qian. For hematemesis due to alcohol damaging the stomach, use Lizhong Tang (Regulate the Middle Decoction) added with Jingouzi (Uncariae Ramulus cum Uncis), Gange (Puerariae Radix), and Maohua (Equiseti Herba). For hematemesis due to excessive alcohol and sexual activity, or irregular eating, an effective formula uses Pipaye, Kuandonghua (Kolkwitziae Flos), Beiziwan (Asteris Radix), Xingren (Armeniacae Semen Amarum), Lurong (Cervi Cornu Degelatinatum), Sangbaipi (Mori Cortex), Mutong (Akebiae Caulis), and Dahuang, ground into powder, made into pills with refined honey, and held in the mouth to dissolve. For internal injury causing hematemesis and hematochezia, or excessive drinking, internal labor injury causing reckless blood flow, gushing like a spring, flowing from mouth and nose, which leads to death if not saved promptly: use Ce Baiye (Platycladi Cacumen) steamed and dried, one liang and half; Jingjie Sui burned to ash, one liang; Renshen, one liang. Grind into fine powder, add one qian of Feiluo Mian (Fine Wheat Flour), mix with fresh well-water into a thin paste, and sip at any time. For stomach injury hematemesis, caused by overeating leading to cold stomach inability to digest, resulting in restlessness, forced vomiting, causing food and qi to rush upward and crush, thereby tearing the stomach opening, presenting with bright red blood, abdominal cramping pain, spontaneous sweating, and a tight and rapid pulse, it is difficult to treat. Use Lizhong Tang added with Chuanxiong and Gange, half qian each; or simply use the base Lizhong Tang added with Chuanxiong and Bian Dou (Phaseoli Semen), which is better, without Gange. If thirst is severe, use Ge Gen (Puerariae Radix); for pills, use Baizhu Wan (Atractylodis Macrocephalae Pill). *Cao Shi Bi Yong Fang* states: For hematemesis, one must decoct Ganjiang (Zingiberis Rhizoma) and Gancao (Glycyrrhizae Radix) to make a decoction to take, or Siwu Lizhong Tang is also acceptable; thus, there is no case that does not heal. If Shengdihuang, Zhuru (Bambusae Caulis in Taenia), or Ou Zhi are used, healing is far away. *San Yin Fang* states: Lizhong Tang can stop stomach-injury hematemesis because it best regulates the middle jiao, separates yin and yang, and stabilizes the blood vessels. If the patient indeed suffers from external cold and ingested cold items, with pathogens entering the blood level, blood congealing due to cold, failing to return to vessels and flowing recklessly, the blood will be dark black, complexion pale and lifeless, pulse micro and slow, body cool. Using cooling blood agents instead of Jiang Gui (Zingiberis Rhizoma and Cinnamomi Cortex) would be dangerous. Physicians attending to diseases should examine carefully. Sometimes bleeding occurs twice, then resolves, only to recur days later, persisting for years without healing; Heishen San and Xiao Wuchen Tang should be taken regularly. Hematemesis patients often develop thirst, named Xue Ke (Blood Thirst). Use Shiquan Dabu Tang (Perfect Great Tonifying Decoction), or Huangqi (Astragali Radix), Renshen, Wuweizi, Dihuang, Maimendong, Gegen, Pipaye, dosed according to stomach qi deficiency or excess. Severe vomiting with dizziness, developing chills and fever: use Jiangqi Tang combined with Siwu Tang, half a dose each, plus one qian of Ejiao. If only fever occurs, use Fuling Buxin Tang (Poria Heart-Nourishing Decoction). Post-hematemesis tidal fever and cough with a surging, large, and rapid pulse exceeding five beats per breath are untreatable. *Jin Gui Fang*: Insufficient heart qi causing hematemesis and epistaxis is primarily treated with Xiexin Tang (Drain the Heart Decoction). Dahuang two liang, Huanglian and Huangqin one liang each. Boil in three sheng of water to obtain one sheng, take in one dose. This refers precisely to insufficient yin qi of the Hand-Shaoyin Heart Meridian, with excessive yang in the same meridian lacking support, causing Lung and Liver to suffer from fire and disease, leading to reckless flying of yin blood. Thus, Dahuang is used to drain excessive fire, Huangqin saves the Lung, and Huanglian saves the Liver, bringing them to harmony, so yin blood naturally recovers and returns to the vessels. Yun Qizi adds Shengdi, naming it Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction). Also stated: For continuous hematemesis, Baiye Tang (Platycladus Decoction) is primary. Baiye and Ganjiang two liang each, Aiye (Artemisiae Argyi Folium) three handfuls. Boil in five sheng of water, add one sheng of Matong (Equi Feces), boil together to obtain one sheng, take warm in two divided doses. Whenever hematemesis does not cease, qi and blood both become deficient; deficiency generates cold. Therefore, Baiye is used. Baiye grows facing west, inheriting the Qi of Dui Metal, which can restrain Liver Wood. Wood governs ascent, Metal governs descent; taking advantage of this ascending-descending pairing, the husband-wife relationship harmonizes, allowing blood to return to the Liver organ. Thus, it is used as the Sovereign herb. Ganjiang is hot in nature, stopping movement without wandering, used to tonify blood deficiency-cold. Aiye's warmth enters internally without flaring upward, allowing yin and yang qi to return inward to supplement cold; these two are used as Ministers. Matong is used because blood is generated by the Heart, which corresponds to Wu (Noon); thus, the excrement of the Wu animal (horse) is used to descend fire and resolve stagnant blood, leading the action as the Envoy. Zhang Zhongjing's treatments for hematemesis rely on these two formulas as the standard; apply this principle to extend to other cases.