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In the summer of the Guiwei year, the wife of Ma Sicai, a fellow townsman, was over fifty years old. Accidentally due to dissatisfaction with external affairs, anger stimulated blood to flow upward and overflow, causing her to vomit several basins of blood daily. The pulse was surging (Hong) and slow (Huan).

I prescribed Xiaoyao San (Free and Easy Wanderer Powder), removing Baizhu (Atractylodis Rhizoma), and adding Huanglian (Coptidis Rhizoma), Chao Zhizi (Gardeniae Fructus fried), and Danpi (Moutan Cortex). After four doses, she recovered.

My commentary: Blood disorders manifest in various ways. There are cases of bleeding from the nine orifices, oozing from the skin and muscles, bleeding from the tongue, gums, or sweat, bleeding from the vertex of the head, and oozing from the armpits and groin. These are all caused by fire pathogenic factors damaging the meridians. One must observe the deficiency or excess of Yuan Qi (Original Qi) to determine treatment and should not rigidly adhere to bitter-cold agents.

Previously, the famous Ming dynasty physician Lv Cangzhou treated a patient who accidentally pricked a boil on his body, causing blood to gush like a spring without stopping. When Dr. Lv examined him, the patient was extremely exhausted, unable to speak, with only the Chi position pulse feeling thread-like (Si), while pulses at other positions were imperceptible. He then prescribed Sini Tang (Recover the Initial Decoction) added with Jingjie (Schizonepetae Herba) and Fangfeng (Saposhnikoviae Radix). The patient's pulse gradually reappeared, and after taking Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction), he recovered after one dose.

He also treated a noble guest suffering from San Yang He Bing (Combined Disease of the Three Yang Meridians), with a long and wiry (Xian) pulse. Due to being startled by wind and waves during a sea voyage, he vomited approximately one sheng of blood, accompanied by hypochondriac pain, irritability, thirst, and delirious speech. Coinciding with that year's annual climate influence causing the Zuo Chi (Left Chi) pulse to be non-responsive, most physicians believed it indicated Kidney Qi exhaustion. Dr. Lv said, "This is a natural harmony pulse; there is no need to worry." He then prescribed Xiao Chai Hu Tang (Minor Bupleurum Decoction), reducing the amount of Renshen (Ginseng Radix et Rhizoma) and adding Shengdihuang (Rehmanniae Radix). Once the Stomach Qi was solidified, he administered Chengqi Tang (Purgative Decoction) to promote bowel movement, and the patient recovered after achieving defecation.

Physicians like Dr. Lv had no rigid biases in their methods, prescribing medicines according to the condition and constitution. People know that cold-natured drugs treat blood disorders but do not realize that warm-natured drugs can also restore life; this is not a comprehensive understanding.

I record below the formula theories of Lizhai (Li Dongyuan): I follow Mr. Liu Zongnong's statement that Ying Qi (Nutritive Qi) is the essence of food and drink. It harmonizes within the Five Zang Organs, spreads throughout the Six Fu Organs, and then enters the vessels. It originates continuously from the Spleen, is controlled by the Heart, received by the Liver, distributed by the Lungs, and excreted by the Kidneys, irrigating the whole body. Thus, entering, exiting, ascending, descending, moistening, and unblocking are all facilitated by this. Therefore, the Classics state: "Qi governs respiration, Blood provides nourishment." It also states: "The Lung directs the Qi of all vessels, the Spleen controls the Blood of all meridians." Qi and Blood are the bellows (Tuoyue) of the human body. Observing these situations, they are mostly caused by improper diet and lifestyle, or imbalance of the Six Exogenous Pathogens (Liu Yin) and Seven Emotions (Qi Qing), leading to damage of Yuan Qi. This causes dysfunction of various meridians, which fail to control and retain blood. The method should be to regulate and tonify the Qi of the Spleen and Liver, allowing blood to return to its origin, and the symptoms will heal themselves. If there is tidal fever, cough, and a rapid pulse, it indicates weak Yuan Qi presenting as false heat; it is best to use sweet-warm herbs to tonify the Spleen and Stomach.

Lizhai further stated: Ancient formulas for treating blood disorders mostly used cold-natured agents, suitable only for people in ancient times whose physical constitution and pathogenic factors were both excess. Patients today mostly have both deficient constitution and deficient pathology. Treaters should seek the root cause and treat accordingly. If the previous symptoms involved damp-heat injuring the Lung causing epistaxis, use Huangqi Yiqi Tang (Astragalus Qi-Supplementing Decoction). If Lung Qi deficiency and heat prevent blood retention causing epistaxis, use Sijunzi Tang (Four Gentlemen Decoction) added with Xiong (Chuanxiong Rhizoma), Gui (Danggui Radix), and Wuweizi (Schisandrae Fructus). If emotional constraint injures the Spleen causing cough and hematemesis, use Guipi Tang (Restore the Spleen Decoction). If Stomach Meridian heat causes cough and hematemesis, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). If Stomach Qi weakness causes cough and hematemesis, use Sijunzi Tang added with Xiong, Gui, and Shengma (Cimicifugae Rhizoma). If Kidney Meridian deficiency heat and internal moving Yin Fire cause hemoptysis and hematemesis, use Liuwei Wan (Six-Ingredient Pill) combined with Buzhong Yiqi Tang (Center-Boosting Qi-Supplementing Decoction). If anger moves Liver Fire causing bleeding, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). If Kidney fluid depletion and moving Liver Fire cause bleeding, use Liuwei Wan. Although it is said that heat causes blood to flow recklessly, there are also cases where Wei Qi (Defensive Qi) is weak and cannot control Ying Blood, leading to reckless flow; this must be carefully observed. All the above conditions belong to deficiencies of the Foot Three Yin meridians with internal moving deficiency fire, not caused by external factors. It is appropriate to use Liuwei Wan and Buzhong Yiqi Tang to nourish the source of transformation; this treats the root. The causes are numerous and cannot be listed exhaustively. Treaters should adapt to clinical situations to avoid errors.

Lizhai further stated: Symptoms such as consumptive cough with blood may be caused by labor injuring Yuan Qi, with internal fire moving recklessly to injure the Lung; or by labor injuring Kidney Water, with Yin Fire flaming upward to injure the Lung; or by excessive consumption of cold herbs like Shengdi (Rehmanniae Radix) and Tianmendong (Asparagi Radix), damaging the Spleen and Stomach so they cannot generate Lung Metal, resulting in non-recovery; or by misuse of herbs like Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), damaging Yang Qi so it cannot generate Yin Essence. All these are due to Spleen and Lung deficiency with insufficient Kidney Water, causing deficiency fire to flare upward and harming the True Viscera. Treatment requires Buzhong Yiqi Tang to tonify Spleen Earth to generate Lung Metal, and Liuhuang Diwan (Six-Ingredient Rehmannia Pill) to nourish Kidney Water to generate Yin Essence; otherwise, rescue is impossible.

In the Yichou year, while residing in Chu, I encountered a female servant over twenty years old who frequently suffered from hematochezia. Physicians prescribed Canglian Wan (Coptis and Cinnabar Pill), and she recovered immediately upon taking it. Previously, a fellow scholar named Liu You, who was handsome and skilled in writing, also suffered from hematochezia. He took Xianglian Wan (Costus and Coptis Pill) for a year without recovery. His diet was normal, and he recovered after marrying in winter and stopping the previous medicine. In the following summer, he suffered from dysentery but could eat heartily and lived energetically. A physician prescribed Xianglian Wan; after only four doses, he fell into Jue (syncope/collapse) at night and died. What a pity! Mostly, long-term accumulation of cold-natured agents gradually injured Spleen Qi. After marriage, essence and blood were consumed daily, and Yuan Qi could no longer support him, hence falling into collapse upon encountering Jue. This is logical. It is like the fall of a home or nation, employing unworthy people: either Yang Qi is lost due to obstinate villains, or Yin fails due to treacherous scholars who appear gentle; disaster does not happen overnight but has a long history.

Furthermore: Various symptoms of Bang Lou (uterine bleeding) in women are often attributed to blood heat causing reckless flow, treated with Siwu Tang (Four Substances Decoction) added with Qin (Scutellariae Radix) and Lian (Huanglian Rhizoma). This is a common method used since ancient times. However, many cases initially stem from labor injuring Middle Qi, or inherent Spleen Qi deficiency failing to control blood, followed by pathogenic heat forcing reckless flow. If initial treatment with the aforementioned decoction fails to stop bleeding after a few doses, one should use Dongyuan's Danggui Shaoyao Tang (Angelica and Peony Decoction) to tonify. If neglected for a long time, leading to sinking of Clear Qi, one should administer Buzhong Yiqi Tang to raise it. The Classics state: "When Yang is dense, solidity is achieved." Ancients said: "In blood loss, tonify Qi." This is an excellent method. Generally, blood deficiency requires concurrent Qi tonification. Blood is like water; Qi is like a dike. If the dike is firm, water does not burst across; if Qi is solid, blood does not flow recklessly. This is the natural principle. This formula uses Baizhu (Atractylodis Rhizoma) as the main ingredient, hence its miraculous effect. Modern physicians do not understand this principle, rigidly adhering to medical texts and indiscriminately using cooling herbs that injure the Spleen. Once Spleen Qi is weak, how can it consolidate blood? This error stems from Liu Shouzhen's assertion that "all blood disorders lack cold," ignoring that "all blood disorders lack excess." Without excess, it is deficiency; deficiency cannot be discussed in terms of lacking cold. Therefore, I specifically highlight and correct this view.