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Section Index
Four Methods to Nourish the Blood
When evil forces gather, the righteous force will inevitably be weak. Not only do we need to replenish the weakened righteous force through tonification, but also through aggressive treatment to quickly eliminate the evil forces and prevent them from weakening the righteous force over time. However, this ointment nourishes the yin fluids in the lungs. Once the lungs are moistened, the leaves droop downward, the qi naturally descends, benefiting the bladder, transmitting to the large intestine, opening all orifices, and benefiting the five organs. If the lung leaves dry out and cannot cover the lower part, the qi will rise instead, making it difficult to lie down and rest, the skin will lose its luster, the bowels will become irregular, the legs will weaken, and the intestines will dry out, leading to all kinds of diseases. Only this ointment moisturizes the lungs, making it an excellent remedy for weakness and dryness. Recently, Huang Kunzai proposed Diopo Tang, which supplements earth to generate metal, and metal to generate water, providing a good basis for lung tonification. In modern times, tea can be brewed with Shengmai San, Huangqi Glutinous Rice Soup combined with Ajiao and Mai Dong, which can effectively replenish the lungs. All of these are meant to nourish the lung yin, addressing the issue of blood loss.
Chen Xiuyuan believes that although blood is yin, it operates with yang harmony; when the heart and lungs’ yang is activated, it shines like the sun and moon, extinguishing all kinds of evil heat, and the blood itself remains undisturbed, circulating smoothly along the meridians. Therefore, there is also a method of warming and tonifying lung yang, using Baoyuan Tang to gently remove the great heat, allowing lung yang to spread and dispelling the darkness; for those with phlegm and cough, add Wuwei and Xingren, or use Liu Jun Tang combined with roasted ginger and Wuwei. The Inner Canon states that exposure to cold and cold drinks damages the lungs. The above two methods are specifically designed to nourish the lungs for those who feel cold. Anyone with yang deficiency who experiences external cold and turbid yin affecting the upper burner should use these methods to support lung yang, which is indeed a good remedy. However, people who have lost blood are often yin-deficient, so if they blindly follow the theory of gently removing the great heat, they are likely to make mistakes. Therefore, those who have studied Xiuyuan’s methods over the years can treat miscellaneous ailments but not chronic fatigue, because his approach leans more toward tonifying yang. From a theoretical standpoint, there is indeed a concept that qi does not capture blood, so among hundreds of prescriptions, there may be one or two that are suitable for tonifying yang, as he lists them side by side for people to examine and explore their variations.
The heart is the “ruler fire,” responsible for producing blood. When blood is deficient and fire is excessive, one suffers from restlessness, insomnia, palpitations, forgetfulness, urinary problems, and mental unrest. Using Tianwang Buxin Dan to activate the heart’s water and connect it to the heart’s fire, prevents the fire from raging and ensures the heart receives proper nourishment. For those whose heart meridian lacks balance between water and fire, this method can replenish the heart’s water and calm the heart. If the problem is not water deficiency but rather blood deficiency and excessive fire in the organ itself, then only blood-nourishing and heart-calming medicines are needed. Zhu Sha Anshen Wan clears heart fire and nourishes heart blood, calming the mind and spirit. Any symptom of palpitations, confusion, or insomnia can be treated with this medicine. If the heart’s yang is not contained, leading to sweating, palpitations, and the heart fire failing to connect with the kidneys, resulting in nocturnal emissions and reddish urine, then use the above two methods, adding Longgu, Muli, Zao Ren, Lianxin, and Fumai to restrain and pacify it—this is the main method for treating heart meridian blood deficiency and excessive fire. For those whose heart meridian lacks fire and cannot produce blood, resulting in emaciation, palpitations, and weak six pulses, it is advisable to use Ginseng Yangrong Tang to nourish the spleen and stomach to supplement the heart. The Inner Canon states that the middle burner absorbs qi and converts it into juice, turning red to become blood. This soup nourishes the heart and transforms blood to serve the whole body, called “Yang to Yin” because it balances the blood, benefiting both qi and blood. Anyone with dual deficiencies of qi and blood can take it. However, for women experiencing heavy menstrual bleeding or postpartum hemorrhage, warming tonification is preferred, as the blood is flowing out and the condition is essentially one of depletion. As for hematemesis, it is a sign of vigorous blood flow and an imbalance in yang, so warming tonification is the least suitable option. Nevertheless, there are cases where yang does not surround yin, leading to massive blood loss and the simultaneous disappearance of both yin and yang, in which case warming tonification becomes essential. Indeed! Clinicians must carefully differentiate diagnoses and not stick rigidly to a single medication. Therefore, recently, those who follow Danxi tend to use only bitter-cold medicines, while those who follow Xiuyuan tend to use only warming medicines—both approaches have their drawbacks.
The spleen governs blood, circulating it up and down, nourishing the four limbs, and is acquired after birth. All five organs receive qi from the spleen, so any tonic must prioritize the spleen. If thinking harms the spleen, leading to inability to capture blood, forgetfulness, palpitations, panic attacks, excessive sleepiness, poor appetite, and irregular bowel movements, then Gui Pi Tang is the go-to remedy. For spleen deficiency accompanied by fever, add Danpi and fried Zizhi; for those with dry lung qi, add Mai Dong and Wuwei; for those with bloating and poor digestion, add Chenpi and roasted ginger, or add Ajiao to nourish the blood, or add Chaihu and Beimu to relieve depression, or add fish glue to solidify the blood. However, Shudi should not be added, as it interferes with the spleen’s ability to govern and circulate. After all, this is a formula that uses yang to generate yin and qi to govern blood, unlike Siwu and Liuwei, which only nourish yin. Moreover, the spleen and liver/kidneys have different methods of nourishing yin; if the spleen is deficient in yin, with frequent fevers and sore throat, then Shen Rou Wu Shu recommends using Yangzhen Tang, decocting the first brew and stopping after two or three brews, extracting the flavorless essence to nourish the spleen—this is a secret method for nourishing spleen yin. Yang Xishan’s Jia Yi Huatu Tang is also quite simple, while Ginseng and pollen are key drugs for generating bodily fluids. People generally know that sand, half, ginger, and cardamom are important for nourishing the spleen, but they don’t realize that if the spleen lacks yang, it cannot digest food properly. Sand, half, ginger, and cardamom are indeed essential, but if the spleen lacks yin, and bodily fluids cannot melt food, then Ginseng and pollen become even more important. Looking at cases of indigestion, when food doesn’t pass through the stomach due to dry gastric juices, it becomes clear that bodily fluids are the key to melting food. Recently, Western medical texts have been introduced to China, often conflicting with the principles of the Inner Canon. In fact, the Inner Canon emphasizes spiritual transformation, while Western medicine focuses on material evidence. Viewed through the lens of the Inner Canon, spiritual transformation can explain material phenomena. However, Westerners meticulously pursue material evidence and rarely see the spiritual dimension. The Inner Canon says the spleen is responsible for grinding food, with the liver and gallbladder’s qi residing in the stomach to help discharge food. Western medicine, on the other hand, claims that food enters the stomach, with sweet meat juice injected to dissolve it, and bitter bile injected into the small intestine to further dissolve it, mixing with gastric juices to complete the digestion process. The Inner Canon talks about dissolving food with qi, while Western medicine talks about dissolving food with juice—there is qi, and there is juice. Nowadays, people read the Inner Canon but don’t understand how the text elevates the coarse to the sublime, ending up using it while neglecting the body, unlike Westerners who pursue material evidence and recognize that food digestion depends on juice. However, Western medicine has this theory, but its application is careless and therefore not instructive. I personally use Ganlu Yin, Qingzao Yangrong Tang, and Ye’s Gastric Nourishing Soup to nourish the stomach, and use Ginseng Guben Tang and Roasted Licorice Soup to nourish the spleen, rejecting Western medical practices and focusing on nourishing spleen yin. Knowing this, I can compensate for the shortcomings of Li Dongyuan’s “Spleen and Stomach Theory.” If the spleen’s yang is weak and cannot grind food, then use Liu Junzi plus Xiangsha to dry it out. If you want to focus on filling the gap, then Zhang Zhongjing’s Xiao Jianzhong Tang is superior, combining yang and yin to treat chronic wasting disease. Although we cannot strictly adhere to it now, understanding its essence allows us to creatively adapt the Gui Pi Tang, Liu Jun, and Bu Zhong Yi Qi formulas to achieve broader effects. Gui Pi Tang draws on the heavy aspects of Jianzhong Tang, while Bu Zhong Tang draws on the light aspects of Jianzhong Tang. This formula, however, contains Gui Zhi yang, which may or may not be suitable for blood conditions, so users should judge accordingly. For example, if the real fire of the Mingmen cannot generate earth, leading to cold vomiting, yin fire rushing upward, red face, nausea, and fullness, then Zheng Yuan Dan can be used to gently warm the fire without risking excessive fire consumption, capturing the essence of Xiao Jianzhong. Ge Kejiu’s White Phoenix Ointment transforms Pingwei San’s dryness into softness, and uses alcohol to deliver the essence of the five grains to nourish the spleen, treating lack of appetite, fatigue, and blood-stagnation—its effect is maximized.
The liver is the organ that stores blood, and the reason blood can circulate throughout the body is thanks to the Chong, Ren, and Dai meridians, which manage it. The blood sea in the womb is where blood is transported and stored, and the liver oversees the blood sea, while the Chong, Ren, and Dai meridians are also under the liver’s jurisdiction. Therefore, when treating blood, the priority is always to nourish the liver. Li Shizhen believed that the liver has no special tonifying methods, fearing that excessive wood would oppress the earth, hence this argument. However, the reason wood oppresses the earth is actually because the liver’s blood is deficient, causing fire to disturb the stomach, and the liver’s qi is deficient, causing water to overflow the spleen meridian—this is how wood oppresses the earth, not because the liver meridian’s qi is abundant. Moreover, most cases of chronic wasting disease in the world are due to liver deficiency, a point already made by Dongyuan in his “Spleen and Stomach Theory.” Few have knowledge of this later on. When liver blood is deficient, it leads to restlessness and insomnia, bone-steaming and nocturnal emission; in such cases, Siwu Tang with Zao Ren, Zhimu, Yunling, Chaihu, Ejiao, Muli, and Gancao should be used to consolidate the liver spirit, nourish liver blood, clear heat, and relieve vexation—this is a method for tonifying yin deficiency in the liver meridian. There is also qi deficiency in the liver meridian, with coldness in the organs and timidity of the spirit, resulting in scattered mental energy; Guiganlongmu Tang can help consolidate and support liver yang, making it suitable for conditions like spermatorrhea due to yang deficiency and palpitations. However, it is particularly appropriate when blood loss has not yet been fully addressed, as it consists entirely of qi-level herbs. Renshushan uses more blood-level herbs, warming and moistening to nourish liver blood, with effects similar to Zhigancao Tang. If the flow of liver blood is obstructed, Huoshi Bujian San can also be used: sour flavors tonify the liver body, while pungent flavors tonify the liver function; the unique ingredient Duohuo helps invigorate qi through wind-dispelling herbs. If Duohuo is omitted and Sangjisheng is added instead, the formula gains the additional benefit of calming wind and stabilizing qi, an idea derived from Xiaoyao San. However, this formula has a rich, heavy aroma and focuses purely on tonifying the liver, whereas Xiaoyao San has a lighter aroma and thus emphasizes harmonizing the liver. Any condition involving stagnation fire in the liver—such as stabbing pain in the chest and flanks, dizziness, palpitations, flushed cheeks, bitter taste in the mouth, alternating chills and fever, night sweats, poor appetite, and a tendency to lie down—can all be treated. Additionally, if there is severe damage to the liver's blood vessels and the pulse becomes weak and irregular, the appropriate approach is to greatly replenish the blood. In such cases, Zhang Zhongjing’s Zhigancao Tang is ideal for greatly tonifying the middle jiao, absorbing qi and extracting essence, while using Gui Zhi to enter the heart and transform redness into blood, ultimately returning it to the liver to nourish all the meridians—making it the premier formula for blood tonification. Traditional physicians often attempt to tonify blood without understanding its source of transformation; even with large doses of Gui and Di, the results are often negligible. If one truly grasps this principle, then the use of Yuanzhi and Zao Ren in Guipi Tang is to tap into the psychological source of blood, while the use of Dan and Zhi in Xiaoyao San is to access the cardiac source of blood purification. From this single insight, many other ingenious applications can be derived. The kidneys are the water organ; when they ascend to nourish the governing fire, water and fire achieve harmony; when they connect with the lung metal, water and heaven become one unified energy. Water rises and fire descends, neither opposing nor clashing but rather complementing each other, so there is no risk of self-immolation. However, if the water yin is deficient and the fire qi is excessive, symptoms such as asthma, coughing, burning sensations, phlegm, blood, tuberculosis, and other ailments will arise. All acquired diseases eventually affect congenital conditions, which is a serious problem. What should be done? Treatment for deficiency must begin early. Dihuang Tang is the primary remedy, replenishing kidney yin while simultaneously reducing fever and promoting diuresis. Reducing fever allows yin to flourish, and promoting diuresis further facilitates the smooth flow of yin. Since the bladder transforms qi, when tangible water qi is discharged downward, intangible water yin rises like dew and spreads throughout the body. To nourish the governing fire, add Gouqi and Yuanshen; to nourish the lung metal, add Shengmai San; for severe fire, add Huangbo and Zhimu. If urination is clear and there is no phlegm or qi disturbance, simply focus on nourishing the kidneys, preferably by taking Zuogui Yin frequently. Huilong Tang nourishes yin and reduces fire, seeking harmony among energies, and performs even better than ordinary plants. For those with yin deficiency and excessive fire—weak legs, dry tendons, bone-steaming dizziness—Daxi Dabuyin Wan can be used to nourish yin and subdue yang, cultivating vital energy through bitter-cold herbs, which is superior to Dihuang Tang. These are methods for replenishing kidney yin. There are also cases where it is necessary to replenish kidney yang. The kidneys are the water organ, but they contain yang qi, which is the life fire. When this fire rises, it becomes thunder dragon fire; when it descends, it becomes original yang qi. By guiding thunder dragon fire back to its roots, we can avoid upper heat and lower cold, dizziness, lower back pain, swelling, asthma, urinary retention, and other symptoms. Using Shenqi Wan to transform yin into yang, replenishing fire and balancing water, can address these issues, and adding Niuxi, Cheqian, or Huangbo and Zhimu can further promote diuresis and reduce fire. If there is no need to transform water but only to replenish yang, then Huangshi Tianhun Tang can be used, derived from Zhang Zhongjing’s Fuzi Tang. Although it lacks the potency of Fuzi Tang, its ingredients are purer and gentler. Blood specialists avoid harsh, drying agents; occasionally, replenishing original yang is also beneficial, and these formulas are excellent choices. When yang in the kidneys reaches the liver, wood becomes warm and blood flows smoothly; when it reaches the spleen, earth becomes firm and grain is transformed. Strong muscles and bones, warm hands and feet, robust defensive qi, and resistance to cold—all indicate sufficient kidney yang. However, kidney water relies on yang for transformation, and kidney yang, in turn, depends on water for containment; this relationship cannot be neglected. Those who wish to replenish the kidneys should carefully consider the above-mentioned methods, as each has its own degree of emphasis and adjustment, and it is not merely about piling up tonics like Zhang Jingyue<sup>(18)</sup> did. In summary, blood-related illnesses fall under the category of deficiency and consumptive diseases, so tonification is indeed appropriate. However, if stagnant evil factors remain unaddressed and tonification is applied too hastily, it may actually leave behind harmful residues, while the body’s righteous qi fails to benefit. Many cases of dried blood disease and tuberculosis have occurred because physicians indiscriminately used tonics, causing old blood to linger and new blood to fail to form. They did not realize that old blood was trapped within the meridians and internal organs, much like wood infested by termites—if the termites are not promptly removed, the wood will never recover. Therefore, Zhang Zhongjing treated dried blood with Dahuang Xichong Wan. Once a deficiency-based illness has developed, and dried blood still remains inside, strong medications must be used to eliminate it; otherwise, the deficiency itself will continue to harbor harmful residues. Thus, in actual clinical practice, tonification formulas should never be used for treating deficiencies alone, and deficiency-based treatments should never neglect real-world therapeutic approaches, lest harmful residues persist. Alternatively, when deficiency and excess coexist, both tonification and treatment can be employed simultaneously, or ten tonifications can be paired with one treatment—this depends on the physician’s skill in managing the situation.
The above discussion provides a brief overview of the general treatment principles for hematemesis, but it does not cover complicated or variant cases in detail. A separate section will be dedicated to these, with detailed analysis and verification, allowing clinicians to refer to it<sup>(19)</sup> for guidance.
〔Notes〕
(1) Mi: tranquility, calmness. (2) Chong: refers to the Chong Meridian, one of the Eight Extraordinary Meridians. It is the “Sea of Blood” because it stores the most blood among the twelve regular meridians, and its qi can surge upward, hence the name “Chong.” (3) Li: attachment. According to the Inner Canon: “The Chong Meridian originates at the Qi Street and runs parallel to the Shaoyin Meridian.” The Nanjing states that it runs parallel to the Foot Yangming Meridian. However, based on its course, it seems more likely to run parallel to the Foot Shaoyin Meridian. (4) Removing the fire from under the pot: a therapeutic method that involves inducing bowel movements to dissipate excess heat, just as removing the fire from under the pot lowers the temperature inside. Commonly used methods include “cold purgation” and “urgent purgation to preserve yin.” (5) Ge Kejiu: (1305–1353 AD), personal name Qian Sun, courtesy name Kejiu. A native of Changzhou during the Ming Dynasty. He authored Medical Enlightenment, Twelve Meridians, and Ten Divine Medicines. (6) Harsh, drying agents: refers to strong medicines. According to the Records of the Grand Historian – Biographies of Bian Que and Cang Gong: “When two yin aspects interact externally and one yang aspect connects internally, strong medicines should not be used. Strong medicines stimulate yang, exacerbating yin disorders and intensifying yang disorders.” (7) Di: however, only. (8) Follow-the-disease method: also known as reverse treatment, which involves adopting therapeutic measures that appear to conform to the disease’s apparent manifestations. (9) Counter-support: adding a small amount of cold medicine to a warm medicine, or vice versa, as a counter-support. In other words, using a drug with properties opposite to the main therapeutic agent as an auxiliary aid. (10) Jué fire: torch. (11) Sweet warmth eliminates great heat: a method for treating febrile conditions caused by qi deficiency. Patients experience body heat, sweating, thirst for hot drinks, shortness of breath, and lethargy. This condition arises from weakness of the middle jiao qi, and can only be resolved by sweet-warming herbs that tonify qi and thereby dispel heat. (12) Bu huo: to disperse. (13) Xun: indeed, truly. (14) Five Books on Caution and Gentleness: written by Hu Shenrou during the Ming Dynasty. Completed in 1636. (15) Diwu: to conflict, to clash. (16) Shu: approximately, nearly. (17) Ke: respectful, cautious. (18) Zhang Jingyue: a renowned physician of the Ming Dynasty. Author of Jingyue Complete Works and other works. (19) Goukao: to explore, to investigate.
〔Commentary〕
The author believes that “qi governs blood” and “blood guards qi”—blood flows thanks to qi, and qi remains tranquil thanks to blood. Like other blood-related conditions, hematemesis ultimately stems from qi stagnation and blood coagulation, qi deficiency and blood depletion, or qi forcing blood to move abnormally. Through clinical practice, the author observed that patients with hematemesis often experience pain in the back and both sides of the ribs, leading him to conclude that, in addition to the stomach, hematemesis is closely linked to the liver and kidneys. This simple yet insightful view is rooted in careful observation and practical experience, and thus shares common ground with modern medical understanding of pulmonary hemorrhage and esophageal variceal bleeding due to cirrhosis.
Regarding the treatment of hematemesis, which is the focus of this volume, the author provides a detailed discussion and elaboration. There are four main therapeutic approaches: stopping the bleeding, eliminating stasis, calming the blood, and tonifying deficiency. This is a highly original synthesis proposed by the author.
Stopping the bleeding: The author emphasizes that blood enters the stomach and is expelled along with the upward-rebounding gastric qi—a phenomenon akin to “turning the world upside down.” Most cases are genuinely heat-related, and the most effective way to stop the bleeding is to use the “remove the fire from under the pot” method to quell the qi and reverse the reflux. The Xie Xin Tang from the Shanghan Lun is the best prescription for achieving this goal. The single ingredient, rhubarb, clears fire and reverses reflux, expelling the old and ushering in the new. Not only does it suppress the reversed qi in the stomach, but it also controls qi reversal that causes blood disorder in the meridians, skin, and body. In addition, the Ten Ashes Powder from the Ten Divine Medicines is often effective for mild cases of hematemesis. Although the fundamental principle of this formula is the simple notion of “stop the bleeding when red meets black,” the inclusion of rhubarb demonstrates its special significance in treating hematemesis. Beyond genuinely heat-related cases, there are also some deficiency-type and cold-type cases, though they are relatively rare, accounting for only about one-tenth to one-twentieth of all cases. These cases are characterized by shortness of breath, confusion, faint pulses, or cold hands and feet, pale complexion, loose stools, and frequent urination, with weak, floating, and scattered pulses. In such situations, Duocan Tang can be used to rescue yang qi, preventing its escape and thus stopping the bleeding. There is also a so-called “true cold with false heat” scenario, where the author uses Gancao Ganjiang Tang to balance yin and yang, allowing yang to sink while yin remains hidden, gradually healing the hematemesis. In summary, the author believes that hematemesis is generally heat-related, with occasional deficiency-type and cold-type cases, mostly due to yang deficiency and qi depletion, indicating an imminent imbalance between yin and yang. Modern medicine holds that hematemesis generally falls under the category of upper gastrointestinal bleeding, and massive hemorrhage often leads to shock or varying degrees of peripheral circulatory failure. The author’s “deficiency-type and cold-type” corresponds to this situation, and using Duocan Tang-like emergency remedies to restore yang is precisely what is needed. Clearly, through extensive clinical practice, the author has achieved accurate and appropriate diagnosis and treatment of hematemesis. Moreover, his assertion that “blood behaves differently depending on whether it is hot or cold—stop when it turns black, and it will also stop when exposed to cold”—though somewhat metaphorical, is nonetheless a valuable conclusion drawn from long-term clinical experience and offers useful guidance for treating blood-related conditions. In addition to the aforementioned major hemostatic methods, the author also discusses a series of adjustments to clinical prescriptions, such as adding Xuefu Zhuyu Tang for blood stasis, Huangqin for severe heat, Yunling and Guashuang for excessive phlegm, Xingren, Wuwei, and Cundong for coughing and wheezing, Qinghao, Sangye, Huangbo, and Muli for night sweats and fever, and Xingren and Suzi for shortness of breath—all of which are clinically feasible modifications. Furthermore, since different triggers lead to different manifestations of hematemesis, the corresponding treatments should also vary. For example, if the cause is overeating greasy and sweet foods, resulting in heat symptoms, Baihu Tang with adjustments is appropriate; if it’s due to external exposure, with wind-cold symptoms, Ma Huang Shaoyao Ren Shen Tang with adjustments is suitable; for wind-heat symptoms, Xiao Chaihu combined with Gypsum and Zhimu is recommended; for epidemic-related causes, Shengjiang San and Xijiao Dihuang Tang with adjustments are advised; and for anger-induced upward movement, the Liver Meridian
the formula is designed to treat sudden, intense surges and discomfort in the chest and diaphragm. The agarwood in the formula calms the qi and balances the Chong, addressing the root cause, while the wu yao warms and disperses the cold qi in the kidneys and bladder to treat the underlying issue. This formula treats both the symptoms and the root cause, making it an effective remedy for reversing and balancing the qi. However, for patients who already have a history of drinking water and whose yang qi tends to rise, Guiling Gancao Wuwei Tang can still be used. The author’s explanation of the mechanism behind calming the blood is based on
its effect, which undoubtedly plays a positive role in preventing recurrence of hematemesis. In addition, he lists numerous prescriptions for treating complications associated with hematemesis, such as using Xiangsu Yin with adjustments for cases with exterior syndromes; using Xijiao Dihuang Tang and Baihu Tang with adjustments for residual heat in the stomach and unstable blood; using Qingzao Jiufei Tang or Baohuo Tang with adjustments for coughing and wheezing; using Xiaoyao San, Longdan Xiegan Tang, and Danggui Luhui Wan with adjustments for liver-fire-related symptoms; and using Xiao Chaihu Tang with adjustments for cases where heat has entered the blood chamber. All of these are effective methods for calming the blood.
Tonification: Although the previous three methods can temporarily stop hematemesis, if the deficiency caused by blood loss is not treated promptly, it can lead to a series of complications, which in turn may trigger a recurrence of hematemesis. Therefore, in addition to the three methods, a fourth method—tonifying deficiency—must be included to achieve more ideal therapeutic outcomes. The author believes that the lungs act as a canopy, regulating the functions of the five zang and six fu organs. “When the lungs are deficient, body fluids dry up, leading to symptoms such as asthma, cough, weakness, and dryness, because the regulation fails and qi rises while blood also rises. No case of hematemesis occurs without damaging lung qi.” Therefore, the first priority is to tonify the lungs. He often uses Xinzi Runfei Cream, Dipotang, Huangqi Jingmi Tang, and Shengmai San, and also borrows Chen Xiuyuan’s method of warming and tonifying lung yang by using Baoyuan Tang to gently remove heat, thereby protecting lung yang. However, since most cases of blood loss involve yin deficiency, only a small number of patients require lung yang tonification. He cautions people that when using Xiuyuan’s method for blood loss, extra care must be taken, as improper use can easily lead to excessive heat and yin depletion. In addition, the author is adept at using Tianwang Buxin Dan and Zhusha Anshen Wan to tonify heart yin and reduce fire, as well as Renshen Yangrong Tang to tonify the spleen and generate heart yang. Regarding spleen tonification, the author advocates using Guipi Tang to tonify spleen qi, Yanzhen Tang to remove head decoctions and nourish spleen yin, and Buzhong Yiqi Tang and Xiangsha Liu Jun Tang to tonify spleen yang. He also argues that bile, pancreatic juice, and gastric juice, as referred to by Western medicine, all fall under the scope of spleen yin. Furthermore, he suggests that Ganlu Yin and Yangwei Tang can nourish gastric juice, while Renshen Guben Tang and Zhigancao Tang with added white peony can nourish pancreatic juice, and Xiao Chaihu Tang with added pinellia and pollen can nourish bile. This integrated Eastern-Western perspective was considered highly significant at the time. As for liver tonification, the author believes that the Chong, Ren, and Dai meridians are governed by the liver, and these three meridians are also responsible for transforming essence and blood.
According to the Shanghan Lun, when liver qi oppresses the lungs, it is called “vertical” (1), and the Qimen acupoint is needled. When liver qi oppresses the spleen, it is called “horizontal” (2), and the Qimen acupoint is also needled. Both methods aim to drain the excess qi. Thus, we know that liver qi can become rebellious and lead to vomiting, especially when it comes to eliminating liver fire—never allow the enemy to thrive. Now, following the intent of Zhang Zhongjing’s acupuncture techniques, we adapt them to herbal medicine, recommending Danggui Luhui Wan with added danpi and puhuang. Anyone experiencing angry vomiting or horizontal liver qi rebellion—characterized by aversion to human voices, a desire to die rather than live, a propensity to draw swords and kill, or wild outbursts of rage and abusive language, regardless of kinship—is suffering from the ruthless fire of the liver meridian, and only a powerful formula can eradicate it. If we delay treatment and let the condition persist, the pathogenic qi will weaken while the righteous qi declines, creating a situation where deficiency overlaps with excess, making it impossible to cure or even attack effectively. It’s like Song Dynasty’s Jia Sidao (3)—nurturing traitors and allowing them to wreak havoc until the nation finally collapses, only to realize it too late! If the condition is slightly milder, but still requires cooling the liver blood and regulating stomach qi, the vomiting will naturally cease. Using Xijiao Dihuang Tang with added chaihu and zhike, the blood will stop after a few doses, followed by Xiaoyao San with added ejiao, moli, and xiangfu to consolidate the results.
Some people often experience acidic or bitter vomiting, especially after blood loss, and this type of vomiting is usually caused by damp-heat. For example, if you leave summer soup overnight, it will turn sour, proving that acidic vomiting is indeed damp-heat. Bitter vomiting, on the other hand, is related to the “fire of the gallbladder,” which is inherently bitter, so the bitterness of the gallbladder can alter the gastric juices and make them bitter. It is advisable to use Zuojin Wan with added blood-tonifying herbs to treat blood-related issues. These two herbs have a strong, cooling effect, making them particularly effective as guides in blood-related treatments.
After hematemesis stops, if the liver and gallbladder fire is still raging, the blood is deficient and restless, the cheeks are flushed, the mouth is thirsty, there is stabbing pain in the chest and flanks, fever and night sweats, and the spirit is unsettled, this indicates that the fire within the liver and gallbladder is extremely intense, potentially leading to bone-steaming tuberculosis. In such cases, Chaihu Qinggu San can be used to treat it. If there is also coughing and itching in the throat, it means that the qi of the liver and lungs is not well coordinated, so Four Reverse Dispersion and Xiangsu Yin can be used, supplemented with Xingren, Zhike, Kuqin, Zhimu, Danggui, and Baipeo to address the issue. If there is often a feeling of air being stuck in the throat (4), or frequent belching and hiccups, it indicates that the qi of the liver and heart is not flowing smoothly, so Xiangsu Yin with added Chaihu, Bohe, Shegan, Niubangzi, Jianbei, Danggui, and Xuanfuhua can be used to resolve the problem. Xiaoyao San is particularly important for treating the liver meridian; with appropriate adjustments, it can always deliver effective results.
Although hematemesis is primarily a liver-gallbladder issue, it is not unrelated to the stomach either. The methods for treating reversed stomach qi have already been discussed in detail in the section on hematemesis. Now, for the sake of completeness, we will add a note for physicians: any blood-related condition accompanied by vomiting should be treated by focusing on the blood first, and once the blood stops, the vomiting will naturally cease as well. For cases where vomiting is accompanied by blood, it’s like “returning food disease” (5)—after vomiting, blood and water appear, indicating reversed stomach qi and blood, a difficult-to-treat condition. Dahuang Maimendong Tang and Mai Men Dong Tang are effective treatments, and Yuniujian with added Puhuang and Ma Ren is also helpful. Four Things Soup with Gancao, Cundong, Zhike, Fuling, Ouchiji, Radish Juice, Ginger, and Jingzhu Oil—all serve to clear stomach qi and nourish blood to stop vomiting.
This article discusses blood, focusing solely on hematemesis, but blood-related conditions rarely occur in isolation—they almost always come with multiple accompanying symptoms. To discuss each symptom in detail, we must categorize them separately. As for prescriptions, they must be adjusted according to the specific symptoms; if we rigidly adhere to a single formula, we’re essentially playing the same tune on a broken instrument (6).
〔Notes〕
(1) Vertical: a situation where the five elements oppose each other. Quoted from Article 109 of the Shanghan Lun. (All references to articles in the Shanghan Lun in this book follow the edition compiled by the Chinese Academy of Traditional Chinese Medicine and published by People’s Health Publishing House in March 1974.) (2) Horizontal: a situation where the five elements cooperate. Quoted from Article 108 of the Shanghan Lun. (3) Jia Sidao: a corrupt official during the reign of Emperor Lizong of the Song Dynasty, who abused power and harmed the country. (4) Stuck: blockage of airflow. (5) Returning food disease: a colloquial term for regurgitation. (6) Playing the same tune on a broken instrument: a metaphor for sticking rigidly to one method without adapting to changing circumstances.
〔Commentary〕The author states that silent blood discharge is hematemesis, while noisy blood discharge is vomiting, citing the Shaoyang syndrome in the Shanghan Lun and the Wujuyu Tang syndrome in the Jingui Yaolue to argue that vomiting is often related to the liver and gallbladder. Although this inference does not fully align with modern medical understanding, the author’s use of formulas like Chaihu Tang and Xiaoyao San for treating vomiting has proven clinically effective. Therefore, this argument is grounded in clinical practice. He also believes that reversed qi is a manifestation of horizontal liver qi rebellion, and that liver qi is prone to anger, with wood and fire rising together, making vomiting a heat-related condition that requires strong, potent medicines to extinguish the fire and stop the bleeding. Consequently, he often uses Danggui Luhui Wan with added danpi and puhuang, while for milder cases of heat, Xijiao Dihuang Tang can also be used. After vomiting, if patients experience flank pain and irritability, it indicates liver-gallbladder stagnation heat, which can be treated with Chaihu Qinggan San; if there is coughing and throat itchiness, it suggests disharmony between the liver and lungs, requiring adjustments to Four Reverse Dispersion and Xiangsu Yin; and if there is a feeling of something stuck in the throat, it indicates poor circulation of qi in the liver meridian, which can be alleviated with Xiangsu Yin plus Chaihu, Bohe, Shegan, Niubangzi, Jianbei, Danggui, and Xuanfuhua. In addition, he points out that there is a long-term vomiting condition that later develops into bleeding, similar to “returning food disease,” which is one of the most difficult conditions to treat. From a modern medical perspective, it might be classified as a tumor in the cardia or esophagus.
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