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Hematemesis due to stomach injury results from excessive intake of alcohol and food, causing discomfort in the stomach; or from forced vomiting, which disrupts Qi and blood flow, damaging the Heart and Stomach, leading to blood being vomited out.

Heishen San (Black Divine Powder) from *Jianyi Fang* treats internal injury to the stomach collaterals caused by excessive drinking and eating, as well as hematemesis resulting from bending over or straining, where bleeding often flows profusely from the mouth and nose.
Herbs: Baicaoshuang (Soot from burning straw, amount unspecified, preferably from rural areas).
Grind into a fine powder. Take 2 qian each time, washed down with glutinous rice soup. Those who prefer cold water may take it mixed with fresh drawn water.

Epistaxis presents with two distinct patterns: exterior cold and interior heat. Exterior cold refers to unresolved Cold Damage (Shanghan) where heat is trapped in the meridians; see the "Cold Damage" chapter for details. Interior heat refers to Heat in the Yangming channel forcing blood to move recklessly, for which Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) is indicated. Alternatively, if Yangming heat cannot descend and instead obstructs upward, *Bacui Fang*'s Xijiao Dihuang Tang should be used to unblock the lower body, after which the upper symptoms will resolve spontaneously.

Patients suffering from various forms of epistaxis should not use Baihu Tang (White Tiger Decoction), nor should those with deficiency patterns. If the condition occurs suddenly accompanied by abdominal pain and diarrhea, only warming methods should be applied.

Luo Qianfu stated: Jin Caiqing consumed rich foods and alcohol for years. In spring, he developed epistaxis. After seeing several physicians who all prescribed bitter-cold herbs to clear heat without success, his diet and lifestyle deteriorated. He experienced cold muscles but occasional restlessness, loss of voice, foul breath, aversion to cold wind, yet residual dripping from the nose persisted. Physicians merely saw blood and assumed heat, using bitter-cold purgatives, unaware that bitter flavors drain Earth (Spleen/Stomach), which is the root of human life. Although Fire pathology exists, draining Earth harms the Spleen and Stomach before clearing the Fire. When Earth is diseased, Stomach Qi becomes deficient; when Stomach Qi is deficient, Ying Qi (Nutritive Qi) fails to nourish the vessels, and Yuan Qi (Original Qi) fails to follow its natural course, transforming with Yin-Cold, resulting in silence and cold muscles. Quackish physicians laughed, claiming it was curable, while the heat pathology remained.

Xiang Yanzhang treated a woman who had suffered from epistaxis for about three years. Physicians believed that blood overflows when heated and administered Heart-draining and blood-cooling agents, worsening her condition. She would faint after only a few drops of blood flowed. Her six pulses were weak, especially at the Cun (Inch) position. Xiang said: The Liver stores Blood, and the Heart governs it. A weak pulse at the Cun indicates Heart deficiency. Heart deficiency fails to govern Blood, causing it to rebel and flow recklessly. The treatment should tonify the Heart and support the Spleen. Since the Spleen is the Child of the Heart, if the Spleen is solid, the Heart will not be deficient. He prescribed Amber and other Heart-tonifying herbs, and she stabilized.

Note: Tonifying the Spleen for Heart deficiency aligns with the principle in *Qianjin Fang* that "when Spleen Qi is prosperous, it influences the Heart." However, specific Spleen-tonifying herbs were not discussed in the original text. I believe one should simultaneously tonify Spleen Yin rather than focusing solely on Spleen Qi.

Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction): Yi Lao (Zhang Yuansu) stated: For treating epistaxis, this formula is superior.
Herbs: Xijiao (Rhinoceros Horn), Shaoyao (Peony Root), Danpi (Moutan Cortex) (each 1.5 qian), Shengdi (Rehmannia Root) (4 qian), Gancao (Licorice Root) (0.5 qian).
Boil in 1.5 cups of water until reduced to 0.8 cup. (*Bacui Fang* adds Dahuang (Rhubarb Radix), Huanglian (Coptis Rhizome), Huangqin (Scutellaria Root)).

Maohua Tang (White Reed Flower Decoction)
Herbs: Baimaohua (White Reed Flower).
Boil in water to make two bowls of concentrated decoction, taken in two doses. If flowers are unavailable, use the roots.

Ren Shen Lian Xin San (Ginseng and Lotus Plumule Powder)
Herbs: Renshen (Ginseng Radix et Rhizoma) (1 qian), Lianzixin (Lotus Plumule) (0.1 fen).
Grind into powder. Take 2 qian with water on an empty stomach until cured.
Another prescription: 50 Lotus Plumules and 50 Glutinous Rice Grains, ground into powder, taken with wine. Treats hematemesis due to mental exhaustion.

Fahui San (Hair Ash Powder)
Herbs: Fahui (Hair Ash) (1 qian), Renzhongbai (Calcinata Urinae Humanis) (roasted and ground, 0.5 qian), Shexiang (Moschus) (ground, 0.1 fen).
Blow a small amount into the nose for immediate cessation.

*Yuanzhu* Jisu San (Elsholtzia Decoction)
Herbs: Jisu Ye (Elsholtzia Leaf), Huangqi (Astragali Radix), Shengdi (Rehmanniae Radix), Ejiao (Donkey-Hide Gelatin), Baimaogen (Imperatae Rhizoma) (each 1 liang), Maidong (Ophiopogonis Tuber) (decored), Jiegeng (Platycodon Radix), Puhuang (Typhae Pollen) (stir-fried), Beimu (Fritillariae Bulbus) (decored), Zhigancao (Prepared Licorice Root) (5 qian).
Take 4 qian per dose with 3 slices of ginger, boiled in water.

Maidong Yinzi (Ophiopogon Drink): Treats Spleen and Lung deficiency, shortness of breath, lack of spirit, epistaxis, and hematemesis.
Herbs: Renshen (Ginseng Radix et Rhizoma), Maidong (Ophiopogonis Tuber), Danggui (Angelicae Sinensis Radix) (each 0.5 qian), Wuweizi (Schisandrae Fructus) (5 berries), Huangqi (Astragali Radix), Gancao (Licorice Root), Shaoyao (Paeoniae Radix Alba) (each 1 qian), Ziwan (Asteris Radix) (1.5 qian).
Cut into pieces, divide into two doses. Boil in 2 cups of water until reduced to 1 cup. Strain and take warm after meals. Another version includes Shengdi (Rehmanniae Radix) but excludes Gancao and Shaoyao.