Spitting Blood 1

Spitting Blood (1)

The spleen is responsible for digesting food and transforming it into body fluids. When these fluids overflow, water yin spreads throughout the body, keeping the mouth clean and fresh, like dew. Therefore, even if one goes all day without drinking, one will not feel thirsty; likewise, even if one keeps the mouth closed all day, no saliva will form. However, when the spleen's fluids fail to disperse cleanly, they condense into saliva. Thus, spitting saliva is due to the spleen's failure to control body fluids. Knowing that the spleen's failure to control body fluids leads to spitting saliva, we can also infer that the spleen's failure to control blood leads to spitting blood. Spitting saliva is normal, but spitting blood is much more serious. After all, body fluids are yin fluids within the qi system, originating in the stomach; when they condense into saliva, the process is relatively close, so the damage is not great. On the other hand, spitting blood originates from the yin aspect. The Inner Canon states: "The spleen is the most yin among the yin organs." All five organs belong to the yin meridians, but the spleen alone is called the Taiyin because it can govern all five organs and serve as the keeper of yin. Its qi flows upward to the heart and lungs, downward to the liver and kidneys, and outward to irrigate the surrounding areas, filling the muscles—this is what it means to be at the center and to flow freely in all directions. Blood follows accordingly, circulating continuously; this is also why the spleen is said to govern blood. Modern physicians do not understand the meaning of governing blood and often mistakenly regard the spleen as a reservoir for blood. How foolish! If the spleen can govern blood, then blood will naturally follow its meridians without wandering aimlessly. But now, blood leaks out into the stomach and is expelled as saliva, indicating that the spleen's yin aspect is diseased and has lost its ability to govern blood normally. If it is determined that the spleen meridian has excessive fire, with dry lips and mouth, severe constipation, and a slippery, full pulse, then it is appropriate to use Xie Xin Tang combined with Dang Gui, Sheng Di, Bai Shao, Hua Fen, Cun Dong, Zhi Ke, Pu Huang, and Gan Cao. If the spleen meridian is deficient in yin, with a thin, rapid pulse, dry body fluids, and restless blood, then Mai Dong Yang Rong Tang combined with Pu Huang and A Jiao, or Jia Yi Hua Tu Tang combined with Sheng Di, Hua Fen, Ren Shen, Cun Dong, Ou Jie, Ce Bai Ye, Lai Fu Zhi, and Zhi Ke are all essential medicines for nourishing and benefiting the spleen's yin (2). If emotional stagnation (3) causes worry in the spleen meridian, damaging the blood and leading to spitting blood, since the spleen is responsible for thinking, every time one worries, the spleen's yin is harmed, sleep becomes restless, there is palpitations and fatigue, and appetite declines. In such cases, it is appropriate to use Gui Pi Tang to tonify both the heart and spleen, adding A Jiao, Chai Hu, Chao Zhi, Zong Hui, and Xue Yu to dispel stagnant fire and purify the blood. This treatment addresses both the spleen and the heart, and is particularly effective for those whose heart and spleen are damaged by overthinking. Furthermore, whenever the spleen meridian is suppressed, the wood energy of the liver is blocked in the earth element of the spleen and cannot ascend, resulting in a lack of yang ascending and internal heat building up. There is no need to clear the heat; instead, one should resolve the stagnation, allowing the yang to rise and the fire to dissipate. Xiao Yao San is the main remedy for this situation.

When the spleen's earth element is yin and requires yang, and when the spleen meridian is deficient in yin and has stagnant fire, the above-mentioned methods are roughly sufficient. There are also cases where the spleen's yang qi is weak, unable to govern yin blood, with a weak heart, cold limbs, poor appetite, spontaneous sweating, and fever. In such cases, Gui Pi Tang can be used to tonify the spleen's yang and generate blood, while Ren Shen Yang Rong Tang and Zheng Yuan Dan are also effective treatments.

There are also cases of spitting blood in the early morning, where one wakes up each day with blood filling the mouth, which is immediately spit out, only to have blood again the next morning. This happens because after lying down, the blood does not return to its proper channels and overflows out of the mouth. In actual cases, this is due to the liver's inability to store blood, often accompanied by headache, thirst, and constipation. In such cases, Dang Gui Lu Hui Wan can be used for treatment. In cases of deficiency, where the spleen fails to govern blood, symptoms such as palpitations, restlessness, and insomnia often appear. In these cases, Gui Pi Tang combined with Dan Pi, Shan Zhi, Zong Hui, and Wu Wei Zi can be used for treatment. This condition is similar to renal deficiency and gingival bleeding, so it is advisable to refer to that section for more information.

Gao Shi Zong (4) said that occasional spitting of blood, occurring after a single cough, can heal on its own without medication, because the blood is close to the stomach, just like blood coming out after a bowel movement. Therefore, no medication is needed. I believe it is also advisable to use fewer cooling herbs, perhaps taking Jia Yi Hua Tu Tang combined with Yin Hua, Zhu Ru, and Lai Fu Zhi. Dan Xi also believed that spitting blood belongs to the kidney, considering spitting and hemoptysis as one and the same condition. Since the path of kidney blood is the deepest and the condition is the most severe, he recommended using Bao Ming Sheng Di San for treatment. I believe that when one first spits phlegm and water, and later spits blood, the blood comes from a distant source and the condition is deep, so Dan Xi's method can be used for treatment. However, there are also cases that Dan Xi's method cannot handle, namely the various formulas I have proposed, which also cannot fully address all situations. One should also consult the sections on vomiting and coughing for additional treatment options, rather than claiming that my discussion is incomplete.

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〔Note〕

(1) Spitting blood: When qi is unobstructed, blood is expelled along with saliva. "Plain Questions · Chapter on the Essence of Pulse Diagnosis": "If the lung pulse is firm and long, one is likely to spit blood." "Plain Questions · Chapter on Coughing": "Severe lung coughing can lead to spitting blood."

(2) Spleen yin: ① Refers to the yin essence of the spleen itself. ② In contrast to stomach yang, the spleen is an organ belonging to the yin category, while the stomach is an organ belonging to the yang category.

(3) Seven emotions: Refers to seven types of mental and emotional changes, including joy, anger, sorrow, worry, grief, fear, and surprise.

(4) Gao Shi Zong: A physician during the Qing Dynasty, author of works such as "Plain Questions Straight Interpretation" and "True Transmission of Medicine."

〔Commentary〕Spitting blood refers to blood being expelled along with saliva. This condition generally does not involve coughing, which helps distinguish it from hemoptysis and coughing up blood. The author argues that when the spleen fails to control body fluids, the fluids condense into saliva; when the spleen fails to control blood, blood and saliva mix, resulting in spitting blood. Therefore, this condition should be treated from the perspective of the spleen. For those with excessive fire in the spleen meridian, dry lips and mouth, severe constipation, and a slippery, full pulse, it is appropriate to use Xie Xin Tang with modifications, aiming to clear fire and reinforce the body. For those with spleen meridian deficiency, dry body fluids, and chaotic blood, it is appropriate to use Mai Dong Yang Rong Tang or Jia Yi Hua Tu Tang with modifications. For those who overthink and have both heart and spleen deficiencies, it is appropriate to use Gui Pi Tang with modifications. For those with weak spleen qi and liver wood overpowering it, leading to symptoms of liver stagnation, it is appropriate to use Xiao Yao San with modifications. If liver fire is too strong, Dang Gui Lu Hui Wan can be used for treatment. The author also points out that the key to treating spitting blood lies in clinical flexibility; one should not rigidly adhere to the above formulas, but rather consult the sections on vomiting and coughing for additional treatment options when necessary. This shows that some cases of spitting blood are related to the stomach, while others are related to the lungs, which is a valuable clinical experience gained by the author.