典藏书目

The *Jiuling Shanfang Ji* records: The monk Lü of Huxin Temple, one day accidentally scratched (the character "Guo", meaning bent) a scabies lesion on his foot, and suddenly began to bleed profusely, like a spring gushing forth. (Myxorrhagia, or subcutaneous bleeding/blood sweat, is called "blood sweat" in the *Huangdi Neijing*. The *Jiyan Fang* recommends wiping with water infused with Scutellariae Radix [Huangqin], a method that has proven effective repeatedly.) The bleeding continued for a whole day without stopping. Surgical physicians treated him without effect. They invited Lü Yuanying to examine the patient. At that time, Lü was extremely exhausted and too weak to speak. When Lü Yuanying palpated the pulse, only the Chi position (Cun Kou pulse location corresponding to the Kidneys/Lower Jiao) was faint like a spider's thread, while pulses at other positions were imperceptible.

Lü Yuanying then told him: "The pulse is the precursor of Qi and Blood. Now that blood is overflowing recklessly, Ying Qi (Nutritive Qi) has suffered a sudden decline. However, the Chi pulses are still palpable. One should tonify Ying Qi to clear deficient Yin fire." Thus, he prescribed Sishen Tang (Four Spirit Decoction) with added Schizonepetae Spica [Jingjie Sui] and Saposhnikoviae Radix [Fangfeng], administered continuously day and night. The next day, the pulse gradually became apparent. He then administered Shiquan Dabu Tang (Ten Great Tonifying Decoction), and after one dose, the patient recovered completely.

In treating hematemesis (vomiting blood), it is appropriate to direct Qi downward, but not merely to clear Fire. Water has the nature of moistening and flowing downward; Fire has the nature of flaming upward. Guiding Qi to descend utilizes the principle of Water overcoming Fire; therefore, directing Qi downward is equivalent to clearing Fire. If bitter-cold herbs are used to clear Fire, Fire will never descend. Because "flaming upward corresponds to Bitter," and Bitter flavor first enters the Heart Meridian, the bitterness of Scutellariae Radix [Huangqin] and Coptidis Rhizoma [Lian] essentially aids Fire in entering the Heart Meridian. They are named "Fire-clearing" drugs solely due to their cold nature. Cold can congeal blood, and Bitter can damage Stomach Qi. This cannot suppress ascending Qi to make it level, nor can it guide overflowing blood back to its source; the harm is incalculable. How can one not be vigilant?

In treating hematemesis, it is appropriate to invigorate Blood circulation, but not to forcibly stop bleeding. In all cases of hematemesis, there is initially no case without chest and hypochondriac pain. This is because irregular daily habits cause Blood stagnation and stasis over a long period, preventing it from returning to its source. When full, it overflows, leading to vomiting. This accumulation is not formed in a single day. If Qi and Blood flow freely and circulate smoothly through the hundred vessels, how could hematemesis occur? Therefore, when treating hematemesis, one must use herbs that invigorate Blood circulation to disperse residual stasis and promote renewal by eliminating the old. Once Blood flows freely, the Stomach region becomes clear, and bleeding naturally ceases. This is achieving hemostasis through promoting circulation. However, physicians often rigidly adhere to formulas like Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction), focusing excessively on cooling Blood. Although bleeding may occasionally stop, patients often subsequently suffer from severe chest and hypochondriac pain, swelling, and distension, leading to deterioration and death. This is because cold causes old Blood to stagnate and new Blood to fail to generate, accumulating more stasis and depleting True Yuan (Original Qi). Moreover, Blood cannot be forcibly stopped; what benefit is there in trying?

This illness arose from prolonged constraint transforming into Fire, compounded by external summer-heat invasion, resulting in torrential hematemesis, which was critically dangerous. Various medicines were rejected by the stomach. I once treated a woman whose condition was critical within moments. Considering that most medicines are bitter and cold, causing immediate vomiting upon ingestion, I borrowed Bazhi Yin (Eight Juices Drink), hoping its sweet-cold nature would enter the Stomach to clear upper heat. We would discuss further once bleeding stopped. The administration proved effective. The formula is recorded in *Zhiyan Lu* (Records of Therapeutic Verification) for reference.

In treating hematemesis, it is appropriate to tonify the Liver, but not to attack/suppress the Liver. The Liver stores Blood; Blood is a Yin substance, which is difficult to form but easy to lose. Furthermore, the Liver belongs to Wood in the East, corresponds to Spring, and is the organ of generation. It should be nourished, not suppressed. Previous physicians claimed "there is no method to tonify the Liver," which is a gross fallacy. After hemorrhage, the Liver store is empty; one is too busy urgently replenishing it to dare use even a slight amount of Liver-suppressing medication. Often, physicians treat hernia and distension conditions by diagnosing excess Liver Fire and using Liver-suppressing drugs, leading to cases where patients develop cyanotic nails and retracted scrotum, unable to recover. This clearly demonstrates that the Liver should not be attacked.

My cousin-yu (wife's brother) Yu Jian'an suffered from hematemesis. Physicians wanted to use herbs to clear Fire, suppress the Liver, and stop bleeding. I wrote to dissuade them. Although he followed my advice and focused on tonification, the condition fluctuated. Generally, after vomiting, new Blood generated would be vomited up again after four or five days. The condition dragged on for years until a San Mai (Scattered Pulse) appeared, indicating that recovery was impossible. He died several days later. Since falling ill, he had never closed his eyes to sleep. The Liver is the organ that stores Blood; when a person lies down, Blood returns to the Liver. Now, the Liver is extremely deficient and insufficient to control Blood. Additionally, Ying and Wei (Defensive) Qi no longer circulate on the exterior. Therefore, he could not close his eyes to sleep, leaving Blood with nowhere to return. With nowhere to return, Blood accumulates over time and is vomited out again; this is the natural law. I failed to think of this at the time and felt remorseful. In the autumn of the Ji-Mao year, I met Miao Zhongchun in Baixia, and we got along very well. He suddenly said to me, "To tonify Blood, one must use Ziziphi Spinosomi Semen [Suanzaoren]." I was suddenly enlightened. Alas! Human thought is limited, while pathological manifestations are infinite. Without broad reading and selective adoption, abandoning one's own views to follow others', even if one is as skilled as Lu Boyuan or Bian Que, errors are inevitable. How much more so for those with mediocre intellect and scant knowledge? I record this as self-admonition to instruct future generations.

Vulgar practitioners often talk of suppressing the Liver, causing significant harm, frequently prolonging it into chronic diseases or even death. They simply do not understand that the Liver is the organ storing Blood, and when lying down, Blood returns to the Liver. If Liver deficiency is insufficient to control Blood, the eyes remain open. By using herbs to tonify Blood and nourish the Liver, such as Poria [Fushen], Longan Aril [Longyan Rou], and Ziziphi Spinosomi Semen [Suanzaoren], selected according to symptoms, Blood finds its return. Thus, physicians should value broad reading and selective adoption, studying with an open mind to compensate for their deficiencies.