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Li Dongyuan stated: Epistaxis (nosebleed) originates from the Lung, and treatment is primarily with Rhinoceros Horn (Xijiao), Cimicifugae Rhizoma (Shengma), Gardeniae Fructus (Zhizi), Scutellariae Radix (Huangqin), Paeoniae Radix (Shaoyao), Rehmanniae Radix Recens (Shengdi), Polygoni Multiflori Caulis (Zishen), Salviae Miltiorrhizae Radix et Rhizoma (Danshen), and Ecliptae Herba (Ejiao). Hemoptysis (coughing up blood) originates from the Kidney, and treatment is primarily with Asparagi Radix (Tianmendong), Ophiopogonis Radix (Mendong), Fritillariae Bulbus (Beimu), Anemarrhenae Rhizoma (Zhimu), Platycodonis Radix (Jiegeng), Stemona Radix (Baibu), Phellodendri Cortex (Huangbai), Polygalae Radix (Yuanzhi), and Rehmanniae Radix Praeparata (Shudihuang). If accompanied by cold signs, treatment is primarily with Zingiberis Rhizoma (Ganjiang) and Cinnamomi Cortex (Rougui). Blood in phlegm originates from the Spleen, and treatment is primarily with Puerariae Radix (Gegen), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Paeoniae Radix (Shaoyao), Glycyrrhizae Radix et Rhizoma (Gancao), Angelicae Sinensis Radix (Danggui), and Aquilariae Lignum Resinatum (Chenxiang). Hematemesis (vomiting blood) originates from the Stomach; excess patterns are treated with Xijiao Dihuang Tang (Rhino-horn and Rehmannia Decoction), while deficiency patterns are treated with Xiaojianzhong Tang (Minor Construct the Middle Decoction) added with Huanglian.

Zhang Yuansu (styled Haicang) stated: Residual fire accumulated in the chest and long-standing Taiyin cold accumulated in the abdomen are separated above and below, causing blockage in the collaterals and obstruction of Yin and Yang. In such cases, bitter-hot herbs should be used to stabilize the middle, and pungent-hot herbs to circulate externally. Sweet-warm herbs should be used to ascend, and pungent-moist herbs to descend, transforming austere energy into spring-like warmth, and changing biting cold into harmonious qi, leading to recovery through sweating. However, residual pathogenic factors remain like dregs, and the body's Yang harmony is not yet fully restored. The patient may feel slight restlessness in the chest and desire cool drinks. If they consume cold food or take cooling formulas, Yang energy is further diminished, and residual Yin cold reactivates. The pulse becomes faint, fine, wiry, and slow. Agitated, this leads to epistaxis or hemoptysis, indicating that the Heart and Lung are affected by pathogens. Progressing downward to melena (blood in stool) or hematuria (blood in urine) indicates that the Kidney and Liver are affected. Bleeding from the Triple Burner presents with dark, dull blood color, caused by heavy damp-cold transforming into toxicity, stagnating the pathways of water and grain, and resulting from infiltration. When encountering bleeding disorders, if the root cause is not investigated and cooling astringents are used blindly, complications will arise. Yang patterns present with bright red blood; Yin patterns present with dark, liver-colored blood.

Bleeding from the upper part is treated with Huangqin Guizhi Tang (Scutellaria and Cinnamon Twig Decoction) and Baishao Danggui Tang (White Peony and Angelica Decoction). Bleeding from the middle part is treated with Danggui Jianzhong Tang (Angelica Decoct to Build the Middle) and Zengsun Weifeng Tang (Modified Wind-Protecting Decoction). Bleeding from the lower part is treated with Xiongguizhu Fu Tang (Ligusticum, Angelica, Atractylodes, and Aconite Decoction) and GuiFu Liuhe Tang (Cinnamon and Aconite Six-Harmony Decoction). If these three types of bleeding occur during the 25 degrees of Yang circulation, Huangqin Sijunzi Tang (Scutellaria and Four Gentlemen Decoction) is used. If they occur during the 25 degrees of Yin circulation, Danggui Sini Jia Wuzhuyu Tang (Angelica Cold-Reversal Decoction plus Evodia) is used.

In cases of hematemesis, epistaxis, and melena, the patient has Yin deficiency with Yang wandering. The pulse is deep and scattered, and external symptoms show deficiency-cold without heat signs. Wujin Wan (Black Gold Pill) and powders should be used to stop bleeding. The method involves using powders for the upper part and pills for the lower part, followed by Muxiang Lizhong Tang (Costus Regulating Middle Decoction) and Daqi Qi Tang (Great Seven-Qi Decoction), decocted with Chuanxiong, and taken with Suhexiang Wan (Styrax Pill) to warm. *Ren Zhai Zhizhi Fang* states: "Blood flows freely when heated, so cooling herbs are mostly used to stop bleeding." However, there are cases of Qi deficiency with cold, where Yin and Yang cannot guard each other, Ying (Nutrient) Qi is deficient and scattered, and blood moves erratically, which is what is meant by "Yang deficiency leads to Yin wandering." External symptoms must show deficiency-cold signs. The treatment should warm the middle to return blood to the vessels naturally. Lizhong Tang added with Nanmuxiang (Southern Costus), or *Ju Fang* Qi Qi Tang added with Chuanxiong, or Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) can be used, showing significant efficacy. Additionally, dietary injury to the Stomach, or Stomach deficiency failing to transport and transform, causes Qi to rebel upward, leading to vomiting and nosebleeds. Muxiang Lizhong Tang and Gancao Ganjiang Tang are indicated. Various bleeding disorders often conclude with Stomach-regulating herbs. One may use Muxiang Lizhong Tang, or mix Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) two parts with Zhike San (Immature Bitter Orange Powder) one part, taken with hot rice gruel. Alternatively, Zhenfang Sijunzi Tang (True Formula Four Gentlemen Decoction) mixed with Xiao Wuchen Tang (Small Black Stagnation Decoction) taken with rice gruel works. All these can be slightly decocted with Shengjiang (Fresh Ginger) and Dazao (Jujube). These drugs not only nourish the Stomach but also work in parallel with Qi-regulating agents. Jiegeng Zhike Tang (Platycodon and Immature Bitter Orange Decoction) mixed with Erchen Tang (Two-Aged Decoction), decocted with ginger and jujube, with a little Suhexiang Wan added, is another superior formula for regulating Qi.

The *Classic* states: "When Fire is excessive in the year, summer heat prevails, Lung Metal is attacked, and the people suffer from blood overflow and discharge." It also says: "When Shaoyang rebounds, Fire Qi erupts internally, causing blood overflow and discharge." This shows that Fire Qi can cause hemorrhage. It also says: "When Taiyin governs, Cold dominates excessively, blood changes within, and the people suffer from hematemesis, blood discharge, rhinitis, epistaxis, and sadness." And: "When Taiyin is in the subterranean position, Cold dominates excessively, and the people suffer from blood manifestations." This shows that Cold Qi can cause hemorrhage. It also says: "When Taiyin is in the subterranean position, Dampness dominates excessively, and the people suffer from blood manifestations." This shows that Dampness can cause hemorrhage. It also says: "In the administration of Shaoyin governing Heaven, Water-Fire, Cold-Heat contend at the Qi intersection. Heat diseases arise above, cold diseases below. Cold and Heat invade and contend in the middle, and the people suffer from blood overflow and discharge." This shows that Cold-Heat invasion can cause hemorrhage. In the administration of Taiyin governing Heaven, in the first Qi period, Wind-Dampness clash, and the people suffer from blood overflow. This shows that Wind-Dampness clash causes blood overflow. It also says: "When Metal is excessive in the year, Dryness prevails, patients cough and reverse Qi, and severely suffer from blood overflow." This shows that Dryness can also cause blood overflow. Thus, all Six Qi can cause hemorrhage; why single out Fire?

*Yingning Sheng Zhi Yan* states: "Ancients said various bleeding disorders are not cold patterns, believing blood is forced by heat to act recklessly, but all involve accompanying factors. Some accompany Wind, some Dampness, some Qi, and some are triggered by medication, with Heat as the root. Treatment for Upper, Middle, and Lower Jiao varies. For the Upper Jiao, use Gardeniae Fructus (Zhizi), Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Paeoniae Radix (Shaoyao), Rhinoceros Horn (Xijiao), and Polygoni Multiflori Caulis (Puhuang), assisted by Rehmanniae Radix Recens (Shengdihuang) and Moutan Cortex (Mudanpi). For Stomach blood, ancients used Weifeng Tang, precisely addressing Yangming Fire Pathogen fanned by Wind, causing blood to move. The presence of Cinnamon Twig (Guizhi) aims to suppress Wood (Liver). For large intestine blood, it is due to Hand-Yangming Fire Pathogen affected by Wind and Dampness. Treat with Fire Agents and Wind Agents, as Wind overcomes Dampness. Use Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Paeoniae Radix (Shaoyao), Phellodendri Cortex (Baipi), Schizonepetae Spica (Jingjie), Saposhnikoviae Radix (Fangfeng), and Notopterygii Rhizoma et Radix (Qianghuo), combined with Celosiae Cristatae Flos (Jiguanhua), following the principle of analogical association. Blood moved by fright belongs to the Heart; anger belongs to the Liver; worry belongs to the Lung; thought belongs to the Spleen; labor belongs to the Kidney. For initial blood overflow, discharge, and reckless accumulation, I usually used Peach Kernel and Rheum Decoctions to break stasis and curb aggression, then treated differently. Although often effective, I did not understand the rationale. Later, in Siming, I met old friend Su Yifangju, who discussed various medical techniques. He said: 'My hometown has a skilled physician who, when treating hemorrhage and reckless accumulation, always uses drastic purgatives first.' Someone asked: 'After hemorrhage, how can the deficiency withstand purging?' He replied: 'Since blood acts recklessly and loses its proper path, if we do not remove accumulation and promote stasis, reckless movement becomes normal. How can we control it? What leaves is pathology; what remains is vitality. Where is the deficiency?' I was startled and said: 'These are profound words!' My past doubts are now resolved.

Women's menstrual blood accumulates to form the fetus; what accumulates stays, what generates grows. After childbirth, lochia is expelled; what leaves leaves, what generates grows. When transformed into milk, it no longer descends, filling until menstruation returns. Hemorrhage is reckless rebellion of blood in blood-pattern individuals; childbirth is normal for women. Their leaving and generating are the same. Hemorrhage patients need purgatives to break blood, applied at the beginning of accumulation/rebellion. Patients with massive blood loss and deficiency should not be purged, as a warning after loss.

[Nine Orifices Bleeding] Nantiantian Yin (Southern Indian Sky Drink) is primary. Alternatively, use Xuanyu Hui (Hair Ash). Naturally shed hair is best; if unavailable, use hair from brothers of the same father; next, male fetal hair; finally, tangled hair. Wash clean with Gleditsiae Sinensis Fructus (Zaojiao) water, dry, burn to ash. Take 2 qian, mixed with decoction of Imperatae Rhizoma (Maocaogen) and Plantaginis Herba (Cheqiancao). Crush fresh Artemisia argyi leaves (Jingye), extract juice, mix with wine. Take one handful of Cirsium japonicum (Ciji), squeeze juice, mix with half cup of wine. If fresh is unavailable, use dried powder, mix with cold water, take 3 qian.

[Bleeding from Skin Pores] Named Jinu (Muscle Epistaxis). Use Renzhongbai (Calculus Humanis) in any amount, scrape onto new tile, bake dry with fire, grind extremely fine. Take 2 qian per dose, add a little Moschus (Shexiang), mix with warm wine. Externally, apply ash of male fetal hair. If ineffective, use Curcumae Radix (Yujin) powder mixed with water, sweep on with goose feather to stop. *Ji Lingshan Fang Ji* records: Monk Lüshi of Huxin Temple scratched a scabies sore, suddenly bleeding profusely like a spring, continuing all day. Surgeons failed. Lü Yuanying was invited. The patient was exhausted, unable to speak. Pulse: only Chi pulse felt like spider thread, others absent. Lü said: 'Pulse is the precursor of Qi and Blood. Now blood rebels, Ying Qi has suddenly declined. But Chi pulses are palpable. Tonify Ying Qi to drain Yin Fire.' Prescribed Sishen Tang (Four Spirit Decoction) added with Jingjie Sui (Schizonepeta Head) and Fangfeng. Administered continuously day and night. Next day, pulse gradually appeared. Then administered Shiquan Dabu Tang (Complete Great Tonifying Decoction) once, and he recovered.

All nine orifices bleeding can use: Moss from wall tops to plug. Plantago juice to drip. Burned lotus seedpod mixed with water to swallow. Pot bottom soot to eat. Pomegranate flower slices to plug. Raw Radish juice to drip. Burned Longgu (Fossilized Bone) to blow into nose. Decoction of Maohua (Reed Flower) to drink. *Yuji Wei Yi* states: The Classic says, Ying Qi is the essence of water and grain, harmonizing five Zang organs, spreading to six Fu organs, entering vessels. It comes continuously, generated in Spleen, controlled by Heart, stored in Liver, announced by Lung, excreted by Kidney, irrigating the body. Eyes see with it, ears hear with it, hands grasp with it, palms hold with it, feet walk with it, Zang organs produce fluids with it, Fu organs generate Qi with it. Thus, entry/exit, ascent/descent, moistening/venting are due to this. Injected into vessels, less causes涩 (roughness), full causes实 (fullness). Daily diet nourishes it, allowing Yang to generate Yin, extracting juice, changing red to become blood. When generation is vigorous, meridians rely on it for nourishment; when depleted, all vessels become empty. Must one not be careful in nourishing? Thus, Blood is Divine Qi. Gain it to live, lose it to die. Knowing blood abundance means physical abundance, blood weakness means physical decline. Calm spirit generates Yin; bodily labor causes Yang hyperactivity. Yang excess leads to Yin decline. Why speak of Yang prosperity generating Yin blood? This refers to the normal state of Qi and Blood, where Yin follows Yang, circulating internally with Qi. Without Yin to restrain, how can Qi stand? Thus, disease arises easily, treatment is difficult. Compared to the theory that 'Yang is often deficient and Yin easily lacks,' we see Yang easily hyperacts and Yin easily fails. Classics say: Yang path is solid, Yin path is deficient; Yin path is often deficient. Yang is often in excess, Yin is often insufficient. Women begin menstruating at fourteen, cease at forty-nine, showing Yin blood is hard to form and easy to deplete. Once Yin Qi is injured, changes follow immediately. Reckless upward flow causes hematemesis/epistaxis; depletion outward causes consumptive fever; reckless downward flow causes red stool; heat accumulation in Bladder causes strangury/hematuria; penetration into intestines causes intestinal wind; Yin deficiency with Yang pounding causes metrorrhagia; damp-steaming heat-stasis causes dysentery; extreme heat putrefaction causes pus-blood. Extreme Fire resembles Water, blood color purple-black. Heat surpassing Yin causes sores/ulcers; Dampness stagnating in blood causes pain/itching; wind-rash on skin causes cold bi. Accumulation above causes forgetfulness; accumulation below causes mania. Abortion, fear, falls cause internal coagulation of evil stasis. Dividing by location: upper half corresponds to Heaven's Yang; lower half to Earth's Yin. This lists manifest symptoms. Treating blood requires blood-specific herbs. Seeking blood herbs, perhaps Siwu Tang (Four Substances Decoction)? Hejian detailed assisting according to patterns, called Liuhe Tang (Six-Harmony Decoction). I state their flavors and key functions, which must be examined. Chuanxiong is Qi herb in Blood, enters Liver channel, pungent-dispersing, moves blood stasis in Qi. Dihuang is Blood herb in Blood, enters Kidney channel, sweet-cool, generates true Yin deficiency. Danggui is main Blood herb, enters Liver channel, pungent-warm, whole use activates blood, returning to respective channels. Shaoyao is Yin branch herb, enters Spleen channel, sour-cool, harmonizes blood, treats deficiency abdominal pain. To seek Yin herbs, take model here. *Piwei Lun* says: Good practitioners adjust according to patterns, selecting one or two suitable herbs as main treatment. This discusses blood diseases seeking blood herbs. If Qi deficiency and blood weakness, follow Changsha (Zhang Zhongjing): tonify blood deficiency with Ginseng; Yang prosperity generates Yin blood. Siwu Tang alone treats blood branch injury when Qi is not deficient. Assisting herbs: Taoren, Honghua, Sumu, Xuejie, Mudanpi for blood stasis. Puhuang, Ejiao, Diyu, Baicaoshuang, Zonglühui for metrorrhagia. Ruxiang, Moyao, Wulingzhi, Lingxiaohua for blood pain. Congrong, Suoyang, Niuxi, Gouqizi, Yimucao, Xiakucao, Beiguiban for blood deficiency. Dairy/blood substances for blood dryness. Ganjiang, Rougui for blood cold. Shengdihuang, Kushen for blood heat. These are general correct treatments. Touching categories extends to infinite changes.

[Diagnosis] Depletion of blood with excess pulse is difficult to treat. If hematemesis recurs with epistaxis, pulse should be deep-fine; floating-large-firm pulse indicates death. Hematemesis/epistaxis with slippery-small pulse indicates life; excess-large pulse indicates death. Sweating or epistaxis with slippery-small pulse indicates life; large-restless pulse indicates death. Hematemesis with chest fullness and pulling pain, small-rapid pulse indicates adverse. Pulse beating, blood-epistaxis with body heat indicates death. Hematemesis with cough-reverse Qi, rapid pulse with heat, inability to lie down indicates death. All bleeding with body heat and large pulse is difficult to treat (pathogen wins). Body cool, pulse quiet is easy to treat (righteous Qi recovers). Epistaxis with only head sweat, no body sweat, or sweat not reaching feet indicates death. Blood overflowing upward, or spitting/vomiting blood, is ominous. Changing to downward flow as diarrhea is favorable. Upward flow is adverse, difficult to treat; downward flow is favorable, easy to treat. Thus Zhang Zhongjing said: In blood accumulation syndrome, if blood exits, it self-heals. If a healthy person suddenly has diarrhea, the disease progresses. Now, bleeding disorder moving upward then downward as diarrhea, pathogen wants to leave, known as auspicious.