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In the autumn of Jiashen year, the second son of Zeng Yigan, a Xialian (successful candidate in the imperial examination), suffered from spermatorrhea for three years. Various treatments failed to cure him. His six pulses were slippery, slow, and weak. I said this was due to Kidney Qi sinking, and Spleen deficiency failing to control water metabolism. The other physicians, adhering strictly to medical texts, treated it with astringent medicines. This treats the branch but forgets the root. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), removing Chaihu (Bupleuri Radix) and Chenpi (Citri Reticulatae Pericarpium), and adding Wuweizi (Schisandrae Chinensis Fructus), Ejiao (Asini Corii Colla), Shudihuang (Rehmanniae Radix Preparata), and Shizao, among others. After two doses, the symptoms stopped. Subsequently, I prepared Jiajian Liuwei Wan (Modified Six-Ingredient Pill with Rehmannia) for him to take. I absolutely avoided Prolongate (Longgu, Os Draconis), Oyster Shell (Muli, Ostreae Concha), and other harsh mineral substances, as well as Jin Yingzi (Chrysanthemi Fructus) and Susu (Papaveris Pericarpium), which are clogging agents; they would only damage the intestines, stomach, and meridians. Whenever I treat this condition, I generally use the aforementioned medicines as the main formula, making appropriate additions and subtractions according to the case, and there has been no failure.

In the late summer of Jiashen year, Lin Zhenbo, a student at the Zhangzhou Academy, who usually enjoyed drinking alcohol, fell ill due to fatigue from travel and irregular eating habits. He contracted an external pathogen. Leukorrhea (white turbid discharge from the urethra) persisted for a month without improvement. I observed that previous treatments had either used acrid-cool fire-draining herbs or tonifying herbs that caused stagnation, leading to abdominal distension and fullness, sometimes accompanied by asthma and refusal to eat. His six pulses were slippery, rapid, yet weak. I said this was due to deficient heat in the Middle Jiao (Spleen and Stomach), causing body fluids to sink into the Bladder, where Qi transformation failed to separate clear from turbid. I used Guipi Tang (Restore the Spleen Decoction), removing Zaoren (Ziziphi Spinosae Semen) and Muxiang (Aucklandiae Radix), and adding Chao Zhizi (Gardeniae Fructus Preparatus), Banxia (Pinelliae Rhizoma), Cheqian (Plantaginis Semen), and Huanglian (Coptidis Rhizoma). After seven doses, the turbidity stopped, urination became clear, and his spirit felt refreshed. Spermatorrhea generally belongs to Kidney deficiency, while leukorrhea often belongs to Spleen heat; although the treatment methods differ, there are distinctions between cold and heat, deficiency and excess.

In mid-spring of Jiashen year, a robust soldier, just thirty years old, who liked drinking and consuming pungent and aromatic foods, suffered from leukorrhea with pain in the urinary orifice. I used Erchen Tang (Two-Aged Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Longdancao (Gentianae Radix), Chishao (Paeoniae Radix Rubra), and Cheqian (Plantaginis Semen). After two doses, the symptoms ceased. Such excess conditions are inherently easy to treat; if tonics are indiscriminately applied, other syndromes will inevitably arise.

My nephew Zhibai’s son, aged thirteen or fourteen, experienced nocturnal enuresis one or twice every night. I said this was due to weak Kidney Qi failing to control urine retention. I prescribed Liuwei Wan (Six-Ingredient Pill with Rehmannia), removing Zexie (Alismatis Rhizoma) and Danpi (Moutan Cortex), and adding Wuweizi (Schisandrae Chinensis Fructus), Yuanzhi (Polygalae Radix), and Luajiao (Cornu Cervi Degelatinatum). After taking it for several months, his previous symptoms completely resolved, and he regained his vigorous and alert demeanor.

My commentary: Regarding various hemorrhagic syndromes, medical classics have discussed them in detail. However, there are differences among the five Zang and six Fu organs, and distinctions between Yin/Yang and deficiency/excess. Blood rising upward is Yang and indicates a rebellious syndrome; blood escaping downward is Yin and indicates a compliant syndrome. Hematemesis originating from the Lung is called cough hemoptysis, sputum hemoptysis, or epistaxis; from the Heart, it is labor hematochezia or lingual bleeding; from the Spleen and Stomach, it is vomiting blood or hematemesis; from the Liver, it is anger-induced hematemesis; from the Kidney, it is spitting blood or salivary bleeding; from the skin pores, it is extravasated blood. These are all cases where Yang Fire carries blood upward. Hematuria primarily involves the Bladder; strangury blood primarily involves the Small Intestine; hemorrhoidal blood primarily involves the Stomach Meridian; melena primarily involves the Large Intestine. Some cases belong to Wind Evil sinking, some to constrained Fire invading the Spleen, some to Damp-Heat injuring the Spleen, and some to accumulated Heat causing dysentery. These are all cases where Yin Fire scorches blood, causing it to flow downward. There are also cases of Heat entering the Blood Chamber, or Cold attacking the Chong and Ren vessels, resulting in blood stasis; or Cold injuring the meridians causing collapse, resulting in a non-fire syndrome. In women, sudden collapse manifests as metrorrhagia (beng lou), while slow oozing manifests as leukorrhea-like bleeding. If Stomach deficiency allows Damp-Heat to invade, red leukorrhea arises. Bleeding from the genital opening constitutes metrorrhagia, leukorrhea, or leukorrhea; bleeding from the large or small intestine, although treated similarly to men, differs when occurring during pregnancy, postpartum, miscarriage, or incomplete abortion. If sudden vomiting, sudden epistaxis, or sudden metrorrhagia does not stop, it indicates isolated Yang and severed Yin, with both Qi and Blood exhausted. One must examine the patient’s age, strength, deficiency, and excess to determine life or death. Regarding treatment methods, some are easy to cure, some difficult, some incurable, some self-healing, some worsened by incorrect treatment, some fatal despite prolonged treatment, some presenting solely as blood disorders, and some accompanied by other syndromes. One must investigate the depth of the pathogen, the decline or vigor of age and physical strength, the suitability or contraindication of the six pulses, and the deficiency/excess and cold/heat of Yuan Qi (Original Qi). Treatment principles must be precise, and prescriptions should not be arbitrary. Only then can premature death be prevented and longevity achieved. If one assumes all cases belong to Fire or Heat and indiscriminately uses cooling and astringent formulas, this may work for Excess Fire and Excess Heat, but for Deficient Fire, Deficient Heat, or non-Fire/non-Heat syndromes, it will invariably damage the Stomach and Spleen, cut off the source of generation and transformation, and hasten death. How can such practices be justified? Generally, the pulse in hemorrhagic diseases should be deep, fine, soggy, and weak, or floating/sinking and harmonious and slow, or surging and large but not rapid, or floating/sinking and slippery and slow, or deficient and minute, or even hidden after sudden massive bleeding. When these pulses match the disease, it is easy to treat. If floating-knotted, floating-leather, or both floating and sinking pulses are choppy, knotted, or short, indicating deficiency with severe disease, it is difficult to treat, though proper treatment can still lead to recovery. If the pulse is floating-rapid, surging-rapid, fine-rapid and non-resilient, floating-large and scattered, choppy-decelerated and weak, slippery but lacking Stomach Qi, wiry-taut, solid-large, or fine-small and forceful-rapid, the disease and pulse contradict each other, indicating incurability. Even with the skill of Lu Bianque, one would be at a loss. Thus, the Classics state: "The pathway of Yang is solid; the pathway of Yin is empty." Yue Ren (Qin Yueren/Bian Que) said: "Kou (knotted) indicates deficiency; Lao (taut) indicates excess." In hemorrhagic diseases, the pulse should be deep and fine; if it reversely becomes floating-large and taut, death ensues, as this is a deficiency syndrome manifesting with an excess pulse. Blood nourishes the collaterals and its nature is Yin and quiet. Before blood loss, collaterals are moist, soft, harmonious, and slow. When Fire forces blood to overflow externally and True Yin is exhausted, Yin is severed and Yang rebels, Fire fills the empty chambers, manifesting as an excess pulse, causing isolated Yang to dominate. How can life persist? Diagnosis must also rely on complexion. After blood loss, if the face is yellowish, greenish-white with spirit, or the patient prefers closing eyes and sleeping, limbs are warm, diet is normal, voice is low and not harsh, this is a compliant syndrome without conflicting signs, considered easy to treat. If the face is dark green/dull, malar flush is sudden, lips/mouth are vermilion, sleep is intermittent with restlessness, body is hot, limbs are cold, breathing is coarse, speech is loud/aggressive, delirium/coma occurs, grasping clothes/twitching muscles happens, sweating is profuse like rain, head sweat only, whole body cold with hot fontanelle, eye sockets sunken, thirst for water, limb edema, continuous umbilical/abdominal colic, Stomach Qi is defeated with vomiting/refusal to eat—these are ominous signs, incurable. Furthermore, analyze the blood color. Test with water: floating indicates Heart/Lung blood; sinking indicates Liver/Kidney blood; neither floating nor sinking indicates Spleen/Stomach blood. This is a general rule. Lung blood is pale with foam; Heart blood is red like vermilion; Spleen/Stomach, being abundant in Qi and Blood, is neither pale nor purple, neither thin nor thick. Liver blood is thick, turbid, and clotted; Kidney blood contains phlegm, appearing as a red thread or pinkish-red, indicating exhaustion of Metal and Water, damage to Lung and Kidney, awaiting death. Another scenario is dual failure of Liver and Kidney: starting with Kidney inflammation and fluid depletion, followed by solitary blazing of Liver Fire forming heavy clots, with incessant vomiting—this is incurable. For Large Intestine melena, distinguish whether it is old stasis before defecation or fresh loss after. For Small Intestine/Bladder hematuria/strangury, examine quantity and clarity. Epistaxis and hematemesis occurring simultaneously from mouth and nose indicate lower rebellion and upper exhaustion. Dysenteric blood that is dark green/black like moss indicates Liver failure, also incurable. Women’s hemorrhages should also be assessed by quantity and clarity, with pulse diagnosis guiding treatment. As the Classics say: "The subtle principle is profound; the obvious manifestations are numerous. Rooted internally but subtle externally, distinction is imperative." Regarding treatment, I list cured cases below; for uncured ones, I detail my theoretical analysis above, adapting to symptoms to avoid missed methods or unjust deaths.