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Hematemesis (vomiting blood) should be differentiated into Yang syndrome and Yin syndrome, requiring particularly careful distinction. This is because hematemesis affects the turbid pathway, unlike epistaxis (nosebleed) which affects the clear pathway. The clear pathway refers to the airway; the turbid pathway refers to the esophagus. If there is no blood in the stomach but blood appears in the stomach and is vomited from the mouth, is it not blood from the stomach? This occurs because orifices in the stomach are not closed, causing blood to flow recklessly.

However, this vomited blood is not merely from the Stomach meridian alone. Blood from the Heart, Liver, Lungs, Spleen, and Kidneys all surge outside the epigastrium and seep into the stomach. Since the Stomach cannot store this blood, it surges upward and is vomited. Nevertheless, blood from the five Zang organs must not be damaged, with damage to the Kidney meridian being particularly severe. Once the Kidney meridian is injured, it may remain uncontrollable for years. This is because the Stomach serves as a gate for the Kidneys; if the gate is not closed, blood from the Kidneys naturally rises to the Stomach, which is an easily understood principle.

Yet, since both involve loss of blood from the five Zang organs, how can one distinguish between Yin and Yang syndromes? There is a reason for this. Hematemesis cannot occur without Fire, nor can it occur without Water deficiency. While people understand hematemesis caused by excess Fire, they struggle to comprehend that caused by Water deficiency. Why? Let me first explain the case with Fire: The Stomach belongs to Earth, yet it often contains Fire. Without the stabilizing Qi of Earth, vomiting transforms into Fire pathogenic factors. Fire residing in the Stomach naturally carries blood upward in a rush. This burning of Yang Fire requires Water to harmonize it. However, blood is a tangible substance; when it pours out like a basin, replenishing Water quickly yields little immediate effect. Therefore, one must tonify Qi to generate Blood. When Qi is generated, it moves; when Qi moves, bleeding stops. There is profound logic within this process. Symptoms must include thirst, toothache, dry throat, red eyes, and fever, indicating Yang syndrome hematemesis. The treatment method requires using Dushen Tang (Ginseng Decoction), taken at a dosage of 1 liang, which is most effective. Next best is Danggui Buxue Tang (Astragalus and Angelica Decoction), which is even more miraculous. If one adds Sanqi root powder (Notoginseng Root Powder) and Jingjie charred (Charred Schizonepeta Herb) powder, each 3 qian, to either of these two formulas and takes them together, bleeding will stop immediately and recurrence will be prevented. Unfortunately, the world does not know this wonderful method, allowing hematemesis patients to develop into Laozai (consumptive disease). This may well be the fault of physicians who treasure their methods too highly and refuse to teach them.

How then is Yin syndrome identified? It may present as several episodes of bleeding per day, chronic coughing over years, blood threads in sputum, worsening at night with no bleeding during the day, or hoarseness. These are signs of Yin syndrome. The treatment must not rely solely on Ren Shen (Ginseng), Dang Gui (Angelica Sinensis), and Huang Qi (Astragalus); instead, purely Yin-nourishing substances should be used. Among physicians, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Fruit) is most suitable. However, such diseases do not respond quickly to just one or two doses. People see the slow action of Liuwei Dihuang Tang lacking immediate results and often abandon it, leading to mild conditions becoming severe and severe ones fatal. Out of compassion, I have devised a divine formula that can be taken long-term without needing to be consumed for three years like the standard pill. This formula mostly nourishes Yin, with a small addition of Yang-tonifying herbs to generate Stomach Qi, and uses herbs that enter the meridians to stop leakage and seal orifices, making it superior to Liuwei Dihuang Tang. Moreover, this medicine is mild and stable without moving properties, which is crucial since blood disorders fear movement above all else.

Prescription: Shudi (Prepared Rehmannia Root, 5 qian), Shanzhuyu (Cornus Fruit, 3 qian), Maidong (Ophiopogon Tuber, 5 qian), Xuanshen (Scrophularia Root, 3 qian), Tiandong (Asparagus Tuber, 1 qian), Cheqianzi (Plantago Seed, 3 qian), Jingjie charred (Charred Schizonepeta Herb, 3 fen), Renshen (Ginseng Root, 3 fen), Shanyao (Dioscorea Rhizome, 5 qian), Yiren (Coix Seed, 1 liang), Baihe (Lily Bulb, 5 qian), Sanqi root powder (Notoginseng Root Powder, 5 fen). Decoct in water and take orally.