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[Xue Ji] Bleeding from sores and ulcers is caused by the deficiency of Qi in the five Zang organs, where deficient fire moves recklessly, causing blood to flow out of its normal channels. One should trace the affected meridians, examine the etiology, and treat accordingly. If bleeding results from Liver heat, use Siwu Tang (Four Substances Decoction) with stir-fried Gardenia Fructus (Zhizi), Moutan Cortex (Mudanpi), Poria (Fuling), and Atractylodes Rhizome (Baizhu). If Liver deficiency fails to store blood, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). If Heart deficiency fails to govern blood, use Siwu Tang with stir-fried Coptis Rhizome (Huanglian), Mudanpi, Fuling, and Baizhu. If Spleen deficiency with heat fails to control blood, use Sijunzi Tang (Four Gentlemen Decoction) with stir-fried Zhizi and Mudanpi. If there is constraint in the Spleen meridian, use Guipi Tang (Restore the Spleen Decoction) with Schisandra Fructus (Wuweizi). If there is Qi deficiency of the Spleen and Lungs, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with Wuweizi. If both Qi and Blood are deficient, use Shiquan Dabu Tang (Ten Ingredients Great Tonifying Decoction). If Yin fire moves recklessly, use Liuwei Dihuang Wan with Wuweizi. Generally, when excessive blood loss presents with symptoms such as irritability, heat, and thirst, regardless of the pulse, one should urgently use Duchang Tang (Single Ginseng Decoction) to tonify Qi. The Classics state: "Blood is generated by Qi." Unless one uses sweet-warm agents such as Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), and Atractylodis Macrocephalae Rhizome (Baizhu) to generate Heart and Liver blood, recovery is impossible. If there is fever and a large pulse, it is incurable. For all hemorrhagic conditions, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) should be used as the primary formula. Tu Jianshan, a Hanlin academician, aged forty, suffered from damp-toxin sores. He mistakenly used preparations containing Calomelas (Qingfen), damaging his Yuan Qi, and the condition persisted for a long time without healing. One evening, upon examination, his Liver pulse was suddenly surging, rapid, and forceful. I asked, "Why is the Liver pulse like this?" The next morning, three or four bowls of dark blood flowed from the sore. He felt fatigued and sweated spontaneously. Although this was frightening, fortunately, the blood was dark and the pulse was calm. I said, "This is the heat toxin of Qingfen; the blood flows recklessly due to its toxicity, allowing the toxin to be expelled. The pathogenic factor is gone, but the True Qi is deficient. One must urgently inject Duchang Tang to replenish him." I valued his character and felt deep compassion, but he was confused by others' advice and did not comply. Consequently, the pathogenic factors lingered endlessly. What a pity! Another patient had a back sore that bled, accompanied by irritability, thirst, a surging pulse that was empty upon deep pressure. This was irritability due to blood depletion. Two doses of Danggui Buxue Tang (Angelica Tonifies the Blood Decoction) brought slight improvement. Subsequently, Bazhen Tang (Eight Treasures Decoction) with Astragali Radix (Huangqi) and Zhizi cured him completely. A woman, after ulceration, vomited approximately three bowls of bright red blood. I stopped the bleeding with Duchang Tang and healed the sore using Sijunzi Tang with Prepared Rehmanniae Radix (Shudihuang), Ligusticum Chuanxiong Rhizome (Xiongui). This illustrates the principle of tonifying Qi for blood depletion, i.e., Yang generates Yin. If cooling-blood and descending-fire cold agents were used, they would further injure the generating Qi of the Spleen Earth. Not only would the blood fail to return to its source, but death would be inevitable. An elderly woman developed a Ding carbuncle on her thumb. After being pricked by someone, bright red blood flowed, and her hand dorsum swelled entirely, causing pain throughout half her body. She had been delirious for five days. I prescribed Huoming Yin (Decoction for Saving Lives). Initially, the pain was localized to the hand. Although the sore was severe, aggressive treatment was inappropriate. I administered one dose of a major tonifying agent, followed by external garlic-separated moxibustion. Fortunately, the swelling on the hand dorsum discharged toxic fluid. After another dose, the swelling gradually ulcerated. Finally, using interior-supporting medicines, she recovered. He Chaoqing, a Southern Ministry of Rites official, promoted to Vice Minister of Shanxi. Upon parting, I noticed his lips and nose were cyanotic and black, and he frequently scratched his back. When asked, he replied, "It is just a small sore!" Upon inspection, it was indeed a Ju abscess. This indicated failure of the Spleen and Stomach, an incurable condition. Knowing we were friends, I pitied his inconvenience in arranging burial during travel, so I asked his colleagues, such as Zhang Dongsha, to detain him forcibly and administered strong tonics. Only purple blood was discharged, indicating extreme deficiency. Some suggested the toxin was too intense to form pus, so he took a cup of attacking/toxic medicine, leading to vomiting, reversal, and pulse disappearance. He indeed died in Nanjing. Zhang Biya, a censor, developed a Ju abscess on his waist. After drinking, he engaged in sexual intercourse. His pulse was surging and rapid, with the two Chi pulses even larger. I declined treatment and prepared to depart by boat, but his son insisted I stay. Soon after, he vomited five or six bowls of foul-smelling blood. I suspected this was reckless bleeding due to deficient fire in the Kidney meridian, likely emerging from the gums. I prepared decoctions separately in jars, including Cinnamon Bark (Rougui) and other herbs to tonify the Kidney and suppress fire. After the bleeding stopped, I wiped his teeth and checked; it was indeed so. I mixed them into one cup for cold administration. The heat and thirst ceased immediately. After a while, I administered another cup warm. His pulse became fine and nearly imperceptible, his breath faint. With the medicine, the pulse slightly recovered, but soon disappeared again. His son suspected pus inside and wanted to lance it. I said, "There certainly is none," and inserted a goose feather tube, confirming my diagnosis. The next day, his pulse vanished, and cold extended up to his knees. His abdomen felt like ice. I urgently prescribed Liujunzi Tang (Six Gentlemen Decoction) with dried Ginger (Shengjiang) and Prepared Aconite Root (Fuzi). Only then did his abdomen warm up, pus begin to drain, and the sore start to heal. However, because his attendants favored his maternal relatives, and he suffered from urinary retention—indicating his Yin essence was exhausted yet he sought sexual gratification to ejaculate, causing internal essence to fail and remain undischarged—I prescribed modified Liuwei Dihuang Wan ingredients with added Renshen and Baizhu. Although his urination improved, the sore failed to close, and he died.

Dongyuan's Shengyu Tang treats continuous bleeding from various malignant sores. Applying fine powder of Hypotrichous Stone (Han Shui Shi) stops bleeding immediately. If the sore occasionally turns black and cannot ulcerate, and medicinal efficacy fades leaving it red and harmonious, this formula is used. If excessive bleeding causes mental restlessness and insomnia, this indicates blood loss, and this formula is indicated.
Prepared Rehmanniae Radix (Shudihuang) and Raw Rehmanniae Radix (Shengdihuang) (each 3 qian), Angelicae Sinensis Radix (Danggui) body (1.5 qian), Ligusticum Chuanxiong Rhizome (Chuanxiong) (2 qian), Astragali Radix (Huangqi) (0.5 fen), Ginseng Radix (Renshen) (0.3 fen).
Cut the herbs. Combine for one dose. Add 1.5 cups of water, decoct to 1 cup. Strain, drink slightly warm at any time. (Note: In this formula, the dosage disparity between Renshen/Huangqi and Danggui/Shudihuang is significant, suggesting an error.)

Jisheng's Xijiao Dihuang Tang treats reckless bleeding due to Stomach fire and blood heat, manifesting as hematemesis, epistaxis, or hematochezia.
Rhino Horn (powdered), Raw Rehmanniae Radix (Shengdihuang), Red Peony Root (Chi Shaoyao), Moutan Cortex (Mudanpi) (each 1.5 qian), Cimicifugae Rhizoma (Shengma), Scutellariae Radix (Huangqin) (stir-fried, each 1 qian).
Decoct in water, add Rhino Horn powder, and take.
If caused by anger, add Gardenia Fructus (Zhizi) and Bupleuri Radix (Chaihu). If Spleen Qi deficiency fails to control blood, use Guipi Tang. If Liver and Spleen fire move recklessly, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If Spleen Qi deficiency fails to govern blood, use Buzhong Yiqi Tang with stir-fried Black Dry Ginger (Pao Ganjiang). If Blood deficiency with fire causes reckless bleeding, use Siwu Tang with stir-fried Ginger (Pao Jiang). If Kidney meridian deficient fire causes reckless bleeding, use Liuwei Dihuang Wan ingredients. If ineffective, urgently add Rougui to guide deficient fire back to its source.

Duchang Tang treats all types of blood loss, or excessive discharge of pus and water, where both Qi and Blood are deficient, presenting with aversion to cold, fever, thirst, and irritability. Since blood is generated by Qi, tonifying Qi for blood depletion follows the principle that Yang generates Yin. Use 2 liang of Renshen, 10 Jujubae Fructus (Zao), and 10 slices of fresh Ginger (Shengjiang). Decoct in water and take slowly.

Modifications of Tuoli Xiaodu San: If pus is abundant and bloody, it indicates Blood deficiency. Remove Jin Yin Hua (Lonicerae Japonicae Flos), Lian Qiao (Forsythiae Fructus), and Bai Zhi (Angelicae Dahuricae Radix); add Danggui, Dihuang, Renshen, and Baizhu. If ineffective, temporarily use Bazhen Tang with Mudanpi. If anger and afternoon fever cause bleeding, it indicates Liver fire and Blood deficiency. Remove the three aforementioned herbs; add Mudanpi, stir-fried black Zhizi, and Shudihuang. If ineffective, temporarily take Bazhen Tang with Liuwei Wan. If face is cyanotic and hypochondriac distension occurs with bleeding, it indicates Liver Qi deficiency failing to store blood. Remove the three herbs; add Cornus Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), and Wuweizi. If ineffective, combine with Liuwei Wan. If poor appetite and fatigue occur with bleeding, it indicates Spleen Qi deficiency failing to control blood. Remove the three herbs; add Renshen, Baizhu, Danggui, and Dihuang. If combined with depression, anger, and insomnia, add Polygalae Radix (Yuanzhi), Ziziphus Seed (Suanzaoren), Poria (Fushen), and Longan Aril (Longyanrou). If ineffective, temporarily use Guipi Tang.