Keywords：专著资料, 全文在线浏览, 尿血
Section Index
Eye Hemorrhage
Both white and black eyes have no orifices for bleeding. The lower eyelid only has tear ducts, which are innervated by the Yangming meridian. According to "Spring and Autumn Annals" (1), when Duke Ai of Cai ran out of tears, he began to bleed, indicating that the blood came out through the tear ducts. The Yangming meridian originates from the Chengqi acupoint, and bleeding from the tear ducts is caused by Yangming dryness and heat. Use Xi Jiao Di Huang Tang with guiwei, chi shao, yinhua, bai zhi, kudzu, niuxi, gypsum, and caoshao to treat it. If wind-heat is severe and bowel movements are blocked, use Tong Pi Xie Wei Tang to clear the spleen and stomach. The Yangming meridian wraps around the eyes, so whenever treating eye diseases, one should also treat Yangming. I have observed "Examination of the Jade Box" (2), which contains a hundred prescriptions for treating eye diseases, and more than seventy of them use rhubarb, indicating that clearing heat from the Yangming stomach meridian is a major method for treating eye diseases. For treating eye hemorrhages, one can draw parallels: all prescriptions such as Bai Hu Tang, Gan Lu Yin, and Yu Nu Jian are Yangming-based, and doctors should judge whether to use them based on the actual condition, and they will all be effective.
Although the eyes belong to the Yangming meridian, they are actually opened by the Liver, and blood is also governed by the Liver. Therefore, when treating eye hemorrhages, the Liver meridian is also crucial. Use Di Gu Pi San with chaihu, fried zhi, yi mu cao, and Dan Zhi Xiao Yao San to treat it. According to the principle, when diseases originate in the Liver, they are often caused by rebellious qi and fire, with symptoms such as tinnitus, bitter taste in the mouth, and stabbing pain in the chest and ribs. In such cases, treatment should focus on the Liver, using the above two formulas as well as Dang Gui Lu Hui Wan and Long Dan Xie Gan Tang. For diseases originating in the Yangming meridian, with symptoms such as fever, thirst, dry eyes and nose, and constipation, treatment should focus on the Yangming meridian.
The small corner of the eye is innervated by the Shaoyang meridian, which originally has no orifices for bleeding. Shaoyang's phase fire flows along the meridian, stimulating the Liver meridian's blood flow and generating blood veins, which then enter the pupil and even grow into meat, sometimes causing bleeding, but not much. Use Xiao Chai Hu Tang with qingpi, danggui, honghua, dancao, and danpi to treat it. External applications such as apricot kernels, white alum, and copper green can also be used.
The big corner of the eye is innervated by the Taiyang meridian, specifically the Jing Ming acupoint. The Taiyang meridian has abundant qi and blood, and the inner corner of the eye forms a red meat lump like a pearl. If there is no meat lump in the big corner of the eye, it is because the Taiyang qi is insufficient. When the Taiyang meridian encounters wind-heat, the big corner of the eye generates blood veins and meat lumps, or slight seepage of blood. External treatment should focus on treating the blood veins and meat lumps. Internally, use Fang Feng Tong Sheng San to remove ma huang, da huang, and mangxiao, then use Fang Feng Gui Chuan Tang to adjust the formula, and apply medicine as described above.
Both of these situations are not true eye hemorrhages, because they involve blood veins and are essentially blood-related diseases, so they are included here. This book discusses blood-related conditions, including eye diseases like membrane opacity, which have dedicated ophthalmology books, so there is plenty of material available. We will not go into detail here.
〔Note〕 (1) "Spring and Autumn Annals": An ancient historical book, traditionally attributed to Confucius. (2) "Examination of the Jade Box": A specialized ophthalmology book written by Fu Renyu during the Ming Dynasty. It consists of six volumes, starting with a general discussion, followed by discussions on specific conditions, covering 108 diseases and their treatment methods and prescriptions, along with ophthalmological surgical techniques, medical cases, illustrations, and mnemonic verses.
〔Commentary〕This condition has two types. The first is caused by the Yangming meridian originating from the Chengqi acupoint, where Yangming dryness and heat attack, leading to eye hemorrhages. Treatment includes Tong Pi Xie Wei Tang, Xi Jiao Di Huang Tang, and Bai Hu Tang with rhubarb. The second type is because the eyes are the Liver's orifice, and blood is also governed by the Liver. For cases showing signs of Liver stagnation and Liver fire, use Xiao Yao San, Dang Gui Lu Hui Wan, and Long Dan Xie Gan Tang. There is also a condition where meat grows in the eye, although it is not strictly an eye hemorrhage, it is related to blood, so we briefly mention the treatment method for reference. For diseases in the small corner of the eye, which is innervated by the Shaoyang meridian, use Xiao Chai Hu Tang with modifications. For diseases in the big corner of the eye, which is innervated by the Taiyang meridian, use Fang Feng Tong Sheng San with modifications.
Ear Hemorrhage
Bleeding from the ear is called ear hemorrhage. The Kidney opens the orifice to the ear (1), but the Kidney meridian cannot reach the head. The Kidney interacts with the Heart, and the Heart's subsidiary organ, the Small Intestine, has a meridian that runs up to the ear, serving as the residence of the god of hearing. The ear is shaped like a pearl, encased in a membrane that holds true water, which is the source of the god's power and the entry point for sound. It connects internally to the brain, serving as an empty space that nothing else can disturb. Even if the Kidney is deficient, if yin fire (2) surges upward, it causes tinnitus; if the divine water is insufficient, it causes deafness. There is absolutely no blood that comes directly from the ear. If blood does come from the ear, it is because the Foot Shaoyang Gallbladder meridian wraps around the ear, and the Hand Shaoyang Triple Burner meridian enters the ear. When phase fire is strong, it collides with Liver qi, which rises upward, and the Small Intestine's phase fire also moves inward, allowing blood to flow freely. Or, due to epidemic rage, fire spreads wildly, invading empty orifices, resulting in ear hemorrhages. Overall, it is a real pathogenic factor, not related to weakness or fatigue, so treatment should focus on the Triple Burner, Gallbladder, Liver, and Small Intestine meridians, which will surely heal. Xiao Chai Hu Tang with Wuling San is the main prescription for treating these conditions. For treating the Liver and Gallbladder, use Long Dan Xie Gan Tang; for treating the Triple Burner, use Chai Hu Mei Lian San; for treating the Small Intestine, use Dao Chi Yin with huangqin, huanglian, bohe, and chuanxiong. All three meridians deal with phase fire, so the treatment methods are largely the same. After recovery, it is advisable to regularly take Liu Wei Di Huang Tang to replenish water and quench fire.
External treatments: Blow Shi Hui San into the ear. Add musk and dragon bone powder and blow them into the ear. Burn wall spider nests and blow the ashes into the ear. Apply swallow nests and mud to the front and back of the ear.
〔Note〕
(1) The Kidney opens the orifice to the ear: According to "Su Wen · On the Great Principle of Yin and Yang," the Kidney "opens the orifice to the ear," and "Ling Shu · On the Degree of Meridians" states: "Kidney qi communicates with the ear, and when the Kidney is balanced, the ear can hear the five tones."
(2) Yin fire: Refers to the virtual fire of the Liver and Kidney.
〔Commentary〕The Foot Shaoyang Gallbladder, the Hand Shaoyang Triple Burner, and the Hand Taiyang Small Intestine meridians are all connected to the ear. Therefore, the treatment of ear hemorrhages should follow the principle that "treatment should focus on the Triple Burner, Gallbladder, and Small Intestine meridians, which will surely heal." The main prescription is Xiao Chai Hu Tang, which unblocks the Triple Burner, relaxes the Liver and Gallbladder, clears the Taiyang meridian, and treats all three meridians. For those leaning toward the Liver and Gallbladder, use Long Dan Xie Gan Tang; for those leaning toward the Triple Burner, use Chai Hu Mei Lian San; for those leaning toward the Small Intestine, use Dao Chi Yin, followed by Liu Wei Di Huang Tang to improve the outcome. The text emphasizes that this condition "is entirely a real pathogenic factor, not related to weakness or fatigue," which is the key point of this article.
Tooth Hemorrhage The teeth, though belonging to the Kidney, are entirely governed by the Stomach in the mouth, because the mouth is the gateway of the Stomach. The alveolar ridge, in particular, is encircled by the meridians of the Stomach; therefore, all cases of epistaxis are due to upward surging Stomach Fire, with blood moving along with the fire. The general treatment principle is to clear Stomach Fire. For cases of actual Stomach Fire—characterized by thirst, swollen gums, fever, constipation, and a full, rapid pulse—use Tongpi Xiewei Tang combined with Pu Huang and Ou Jie for treatment. If there is no constipation, there is no need for purgation; simply use a cooling formula: Xijiao Dihuang Tang with Gegen, Guan Zhong, Zhike, and Lai Fu Zhi.
For cases of deficient Stomach Fire—marked by dry mouth, ulcerated gums, a fine, rapid pulse, and blood deficiency—use Ganlu Yin with Pu Huang to stop the bleeding, and Yu Nu Jian to guide the Stomach Fire downward while nourishing yin.
Both of these formulas address the deficiency or excess of the teeth and gums, and both conditions are related to fire. If wind is present within the fire, add Fang Feng and Bai Zhi. If dampness accompanies the fire, add Fang Ji and Mu Tong. There are also cases of kidney deficiency with excessive Stomach Fire, resulting in tooth decay (1) and blood seepage, as well as situations where blood flows during sleep but stops upon waking—these are all due to yin deficiency and failure of blood to be retained. In such cases, use Liu Wei Di Huang Tang with Niu Xi, Er Dong, Sui Bu, and Pu Huang. When the upper part is excessive and the lower part deficient, with a weak pulse at the cun position and a floating, large pulse at the chi position, add Gui Fu.
External treatment methods include rinsing the mouth with cold water, based on the principle that blood coagulates when exposed to cold. Rinsing with vinegar is intended to draw the blood inward through its acidity. Applying Baicao Shuang Shen (2) or Shihui San Shen can stop the bleeding when the blood turns black, as this also helps to clear and reduce the fire; once the fire subsides, so does the bleeding. Using Kuhuan, Wubeizi, and earthworms ground into powder and sprinkled on the teeth can further strengthen them.
[Notes]
(1) Huo: to crack or rupture.
(2) Shen: to adhere or stick.
[Commentary] The teeth are located in the mouth, which serves as the gateway of the Stomach; therefore, treating tooth-related bleeding should focus on regulating the Stomach. For actual Stomach Fire, use Tongpi Xiewei Tang or Xijiao Dihuang Tang; for deficient Stomach Fire, use Ganlu Yin or Yu Nu Jian. If wind is present within the fire, add Fang Feng and Bai Zhi; if dampness accompanies the fire, add Fang Ji and Mu Tong. For cases of kidney deficiency with excessive Stomach Fire, use Liu Wei Di Huang Tang with appropriate modifications.
Tongue Bleeding
The tongue is the sprout of the Heart. Observing children who stick out their tongues or play with them (1), as well as those with a wooden or heavy tongue (2), the primary treatment focuses on eliminating Wind-Fire from the Heart Meridian. Thus, we know that tongue bleeding is always due to excessive Heart Fire, with blood being forced out by the heat. The general treatment principle is to clear Heart Fire, using Dao Chi Yin with Huang Lian, Da Li, Lian Qiao, Pu Huang, Niu Xi, and Yuan Shen for treatment. For cases of severe tongue swelling and heavy bleeding, the fire is too intense, so use Xie Xin Tang. For those with irritability and confusion, use An Shen Wan with Tong Bian and Xue Yu Hui for treatment. Although the tongue is the sprout of the Heart, the mouth is the gateway of the Stomach, and since the tongue is in the mouth, it can also bleed due to Stomach Fire. For those with severe constipation, use Yu Zhu San with Yin Hua for treatment. For those with thirst and fever, use Zhu Ye Shi Gao Tang with Pu Huang and Ou Jie for treatment. The tongue itself is connected to the Liver Meridian, so if blood seeps under the tongue, it indicates Liver pathogenic heat. Use Si Wu Tang with Tao Ren, Hong Hua, Chao Zhi, Dan Pi, Niu Xi, and Chi Ling for treatment. In severe cases, use Dang Gui Lu Hui Wan or Long Dan Xie Gan Tang. Although tongue bleeding may seem similar, the underlying patterns vary depending on whether it originates from the Heart, Stomach, or Liver. Therefore, treatment should be tailored to each organ rather than forcing a rigid distinction.
External treatment methods are the same as for tooth bleeding.
[Notes]
(1) Tu She Nong She: sticking out the tongue and letting it hang loosely is called "tu she"; slightly extending the tongue and then quickly retracting it to lick the lips and corners of the mouth is called "nong she." Both behaviors are seen in cases of Heart-Spleen excess heat, where toxic heat attacks the Heart, as well as in children with congenital deficiencies.
(2) Mu She Chong She: "wooden tongue" refers to a swollen, rigid tongue that cannot move; "heavy tongue" refers to congestion of veins under the tongue, causing swelling.
[Commentary] The tongue is the sprout of the Heart, and since it is located in the mouth, which is also the gateway of the Stomach, the Liver Meridian is closely connected to the tongue. Therefore, tongue bleeding is most closely related to the Heart, Stomach, and Liver. For cases related to the Heart, use Xie Xin Tang or Dao Chi San; for cases related to the Stomach, use Yu Zhu San or Zhu Ye Shi Gao Tang; for cases related to the Liver, use Si Wu Tang combined with Tao Ren, Hong Hua, Dan Pi, Zhi Zi, Niu Xi, etc.
Severe Bleeding
Severe bleeding refers to bleeding from all nine orifices (1). This is not an epidemic or major toxin; rather, it is a condition of extreme toxicity. The human body has nine orifices, and when all nine are affected, it becomes a life-threatening situation, making treatment difficult. Only sudden fright leading to bleeding from all nine orifices can be treated with Zhu Sha An Shen Wan combined with Fa Hui for treatment.
[Notes]
(1) Nine orifices: ① two eyes, two ears, two nostrils, mouth, front genitalia, and back genitalia. ② two eyes, two ears, two nostrils, mouth, tongue, and throat (as described in "Nan Jing · Thirty-Seven Difficulties").
[Commentary] Besides epidemics and major toxins, bleeding from all nine orifices can also be caused by certain hematological disorders. The differentiation of these types of bleeding is complex, and the author has not been able to cover everything here.
Zero Blood
Zero blood refers to the appearance of tiny, yellowish-white specks resembling rice grains or beans, emitting a very pungent odor, mixed within the sputum rather than being part of the sputum itself. This occurs after blood has been expelled, as the blood's stagnant heat transforms into these specks, or even before blood is expelled, when the blood's heat forms these specks first, followed by actual bleeding. Overall, this phenomenon arises from the transformation of blood's stagnant heat. Treatment should focus on clearing heat and transforming blood, reducing qi and eliminating phlegm, since it resembles phlegm and must arise from qi and phlegm. For cases where zero blood appears before actual bleeding, the main approach is to reduce qi and eliminate phlegm. At this stage, the blood has not yet moved, but addressing the qi will naturally resolve the zero blood issue. Use Huo Tan Wan or Xiao Chai Hu Tang for treatment. For cases where zero blood appears after actual bleeding, the primary focus is on clearing heat and transforming blood. Since the blood has already been expelled and is now stagnant and heated, it is necessary to treat the blood stasis as well. Use Tai Ping Wan or Sheng Di Huang San for treatment. This condition is not mentioned in ancient texts, but the author often encounters it in clinical practice, hence the name and detailed discussion, to fill a gap in the classification of blood-related syndromes.
[Notes]
(1) Zero Blood: A term coined by the author, referring to the pungent, fishy-smelling discharge that resembles tiny rice or bean-sized particles.
[Commentary] Modern medical conditions such as pulmonary abscess and caseous pneumonia may exhibit symptoms similar to this syndrome. The treatment principle is to clear heat and transform blood, reduce qi and eliminate phlegm, using Xiao Chai Hu Tang, Tai Ping Wan, and Sheng Di Huang San. This syndrome was defined by the author through long-term observation and represents a valuable addition to traditional Chinese medicine.
Pus Emission
Pus is a transformation of blood. When blood does not obstruct qi and qi does not fight blood, the blood and qi are in harmony, and sores and boils do not form. However, when blood stagnates and qi is blocked, it condenses into pain; when qi steams blood, it decays into pus. External lesions are relatively easy to treat, but when it comes to pus emission,
The qi of the human body is transformed from water, so qi is essentially water. Therefore, when blood undergoes the transformation of qi, it also becomes water, but instead of being called water, it is referred to as pus because it still retains the essence of blood, albeit more concentrated than ordinary water. Before it transforms, it remains blood; if blood stasis is cleared, pus will not form. Once it has transformed, it is like water, and if you drain the water, the pus will naturally be expelled.
One lung abscess (1): Located between the third rib above the breast, known as the Lung Meeting Point, there is a dull ache, and eating beans makes one feel fragrant—this indicates that an abscess is forming. Zhang Zhongjing said: “When wind resides in the lungs, people cough, experience dry mouth, shortness of breath, and a dry throat without thirst, occasionally spitting up turbid mucus, and sometimes feeling chills. As heat passes through, blood becomes stagnant and accumulates into abscesses and pus, which is expelled like rice porridge. If caught early, it can be saved; if it becomes pus, it’s fatal.” (2) He added that if the lungs are severely damaged, death is inevitable, but even if they are not, there is still hope for recovery. Therefore, Zhang Zhongjing also said: “If you have a dry, irritating cough (3), a dull ache in the chest, a rapid and strong pulse, difficulty breathing and lying down, and nasal congestion with loss of smell, use Ting Li Da Zao Xie Fei Tang for treatment. If the pus is expelled like rice porridge, use Gan Ju Tang for treatment.” Zhang Zhongjing’s argument is not that there are no other treatments besides these two formulas, but rather that for cases where pus has not yet formed, one should focus on draining the stagnation, while for cases where pus has already formed, one should focus on breaking the blockage—providing two pathways for treatment so that people know what to do. Moreover, he emphasized that these formulas have flexible adjustments, which are implied in his words. Based on this, I expanded on the two concepts of draining stagnation and breaking blockages: for cases where pus has formed, use Tong Qiao Huo Xue Tang with Ma Huang, Xing Ren, Shi Gao, and Gan Cao to drain the pus from the surface; for cases without surface symptoms, use Ren Shen Xie Fei Tang with Ting Li and Da Zao to drain the pus from within; and if the condition is severe and requires both external and internal treatment (4), use Fang Feng Tong Sheng San. These three approaches are stronger than Zhang Zhongjing’s method of draining stagnation, allowing us to fully utilize their potential. If one lacks the ability to choose, using only Gan Ju Tang with Jing Jie, Bo He, Xing Ren, and Huang Qin is acceptable, but ineffective. For cases where pus has already formed, it is crucial to remove the pus, preferably by expelling it through the mouth. Use Qian Jin Wei Jing Tang, or Guai Ti San with Dong Gua Ren, Tao Ren, Yi Ren, and Zhi Zi, or Xie Bai San with Huang Lian and Gua Lou. All of these aim to expel the pus from the diaphragm, keeping it away from the body to prevent prolonged complications. Xie Bai San is particularly effective at both expelling and draining, adding Sheng Ma and Yu Jin to enhance its expulsion and drainage capabilities, and incorporating Huang Qin and Gua Lou to better control the fire. If one only needs to drain the pus without expelling it, combine Gan Ju Xie Fei Tang with Chi Dou Ya, Yi Ren, Fang Ji, Gua Lou, Xing Ren, Zhi Mu, and Zhi Ke to facilitate the descent, or use Ju Jing Ning Fei Tang to balance the effects of both expelling and draining. In this way, we can fully realize the benefits of Zhang Zhongjing’s method of breaking blockages, although the method of sealing the opening has not been discussed by him, it can still be inferred from the principles. All wounds require warming and tonifying treatment; the lungs are a metal organ, and warming helps to temper the metal, so it is best to cool and restrain the metal to help it thrive. Use Ren Shen Qing Fei Tang for treatment, followed by Qing Zao Jiu Fei Tang to consolidate the results.
One spleen-stomach abscess: The treatment method is similar to that of lung abscess. However, lung abscess is often caused by external wind pathogens, so there is a method of releasing the exterior. Spleen-stomach abscess, on the other hand, is caused by internal accumulation of damp-heat, alcohol toxins, and emotional fire, so there is no method of releasing the exterior. At the onset of a stomach abscess, the Zhong Wan acupoint (four inches above the navel) will feel a dull ache. At the onset of a spleen abscess, the Zhang Men acupoint (two inches above the navel, six inches to the side) will feel a dull ache. Both diseases are characterized by a fragrant smell when eating beans, with symptoms of alternating cold and heat like malaria, rough skin resembling overlapping scales (5), abdominal distension, and dry throat. The treatment principle is to attack the heat and drain the blood; once the heat is gone, the blood will continue to flow, and it will naturally turn into an abscess or pus. Therefore, for cases where internal abscesses have not yet formed, the main approach is to eliminate the stagnant heat and blood stasis, using Dan Pi Tang for treatment. For cases where pus has already formed, the main approach is to drain it, since pus is essentially water, and draining water means draining pus. Use Chi Dou Yi Ren Tang for treatment. After the pus and blood have been drained, the organs become empty, and if signs of fire appear, use Ren Shen Gu Ben Tang with Huang Qi and Fu Ling to replenish and strengthen them; if signs of cold deficiency appear, use Liu Jun Zi Tang with Huang Qi, Dang Gui, and roasted ginger to warm and tonify. There are additional formulas available, depending on the accompanying symptoms, and they can be used as needed, though it is difficult to list them all here.
In addition, any area with stagnant heat and blood stasis—such as the chest, back, waist, flanks, liver, diaphragm, and small and large intestines—can develop abscesses, and Dan Pi Tang is the primary treatment for all of them. For areas closer to the upper burner, add Ding Xiao, Ting Li, Huang Qi, Ju Jing, Jing Jie, and Gan Cao. For areas closer to the lower burner, add Jiang Huang. Details regarding the specific treatment for each type of abscess are provided below.
This book originally focused on blood-related syndromes, so it also discusses internal abscesses, since abscesses and pus are all caused by blood accumulation. Understanding how blood transforms into abscesses and pus allows us to understand how blood can lead to dried blood and tuberculosis. Knowing how internal abscesses generate alternating cold and heat also helps us understand the hidden heat in blood-related syndromes. However, abscesses and pus are fundamentally different from blood deficiency syndromes, as they involve actual blood accumulation. Nevertheless, we cannot rely solely on this distinction to fully understand the nature of blood-related syndromes.
[Notes] (1) Lung Abscess: A condition in which the lungs develop abscesses and produce pus, cough, and sputum, similar to pulmonary abscess and lung gangrene. (2) Quoted from "Jin Gui Yao Lue · Lung Deficiency and Lung Abscess Cough and Shortness of Breath Chapter." (3) Dry, Irritating Cough: Describes a very dry mouth when coughing. "Jin Gui Yao Lue · Lung Deficiency Chapter": "If the mouth is extremely dry, coughing will cause a dull ache in the chest." (4) External and Internal Treatment: Refers to treating both the surface and the interior simultaneously. (5) Rough Skin Like Overlapping Scales: Described in "Jin Gui Yao Lue · Blood Stasis and Weakness Chapter": "The skin is rough and scaly, with dark circles under the eyes."
[Commentary] This section divides abscesses into lung abscesses and spleen-stomach abscesses. The principle in "Jin Gui Yao Lue" that abscesses should be drained when they are not yet formed and opened when they have already formed is the main basis for treating lung abscesses. The author proposes using Ma Xing Shi Gan Tang combined with Tong Qiao Huo Xue Tang, Ren Shen Xie Fei Tang combined with Ting Li Da Zao Xie Fei Tang, and Fang Feng Tong Sheng San, adjusting the dosage as needed to drain stagnation. For opening blockages, use Qian Jin Wei Jing Tang, Guai Ti San with Dong Gua Ren, Tao Ren, Yi Ren, and Zhi Zi, as well as Xie Bai San with Sheng Ma, Yu Jin, Huang Qin, and Gua Lou. The author believes these formulas are more effective than the methods described in "Jin Gui Yao Lue"—draining stagnation with Ting Li Da Zao Xie Fei Tang and opening blockages with Gan Ju Tang—and suggests that during the recovery phase of lung abscesses, Ren Shen Qing Fei Tang and Qing Zao Jiu Fei Tang can help promote closure.
Regarding the treatment of spleen-stomach abscesses, the author points out that "the symptoms are like malaria, with rough skin, abdominal distension, and dry throat," and advocates using Dan Pi Tang to attack the heat and drain the blood for cases where pus has not yet formed. If pus has already formed, use Chi Dou Yi Ren Tang to drain the pus and break the blockage, and after recovery, use Ren Shen Gu Ben Tang to replenish and strengthen the body. Based on the symptoms and the effectiveness of the formulas, it seems that spleen-stomach abscesses may also include some suppurative lesions in the liver, gallbladder, and appendix.
Sweat and Blood
Sweat is water derived from qi, originating from the bladder. According to the "Inner Canon," "The bladder is the official of the state, storing fluids and transforming them into qi for release." (1) Bladder qi travels through the Three Jiao, permeating the muscles and reaching the skin and hair, thereby protecting the exterior. Yang qi protects the exterior, preventing all evil influences from entering, which is why this meridian is called the Sun. During periods of intense summer heat, the sun's yang energy heats the bladder's water, causing it to evaporate outward and manifest as sweat—just like rain falling from the sky, with yang spreading and yin harmonizing, resulting in natural health. Sometimes, however, external wind-cold invades, causing the skin and hair to open up and sweat profusely—this happens because the Sun's qi is afflicted by evil forces and can no longer protect the exterior, allowing sweat to escape. Similarly, diseases involving heat and dampness in the Heart, Stomach, Liver, or Spleen can also cause sweating—just like humid, sweltering weather (2), which can also generate clouds and rain. There are also cases of spontaneous sweating due to depletion of yang qi, where the original yang qi of the bladder and kidneys leaks out, causing the yin water to overflow and disperse uncontrollably. Since qi is transformed from water, and water is qi, sweat is also water. When qi escapes outward, sweat is produced. Understanding this reveals that sweat originates from qi, not from blood. However, although sweat comes from qi, it is still closely related to blood; when blood is hot, it can also heat the qi, leading to night sweats. This is because blood and qi are inherently interdependent—when yin blood is abundant, yang water naturally fills up, and when yang water is sufficient, it can spread and moisten (3), making yin blood even more nourished and harmonious (4), thus preventing yang from overpowering yin. If yang water is insufficient, it harms yin blood, leading to insomnia and restlessness when one sweats excessively due to cold, as it also damages yin blood, which is controlled by the Heart. The Heart controls blood, and when yin blood is harmed, the Heart's qi becomes unstable. Additionally, when one suffers from cold, one should normally relieve it through sweating, but if one cannot sweat, one resorts to nosebleeds instead, which are called red sweat. This is because yang evils tend to take advantage of yang water to go outside, but when they cannot, they invade yin blood through nosebleeds, resulting in red sweat—a manifestation of yang evils invading yin. Ancient texts say that when yang invades yin, one experiences nosebleeds; knowing that yang invades yin and causes internal conflict leads to nosebleeds, while knowing that yang invades yin and causes external leakage leads to skin sweat. Blood is the liquid of the Heart, and skin is the union of the Lungs, so treatment should focus on clearing Heart Fire, so that yang does not overpower yin, and also on regulating the Lungs, so that the skin does not leak. Use Liang Xue Di Huang Tang with Sang Pi, Di Gu Pi, Chan Tui, Bai He, and Pu Huang for treatment. For cases of severe blood deficiency and excessive yang fire, use Dang Gui Liu Huang Tang; for cases of qi deficiency and low blood, use Dang Gui Bu Xue Tang with Sang Pi, Di Gu, Dan Pi, Chan Tui, Palm Charcoal, Huang Qin, and Qin Pi for treatment. Apply lime powder externally, imitating Zhang Zhongjing's approach of using warm powder to stop excessive sweating.
It's the same. This kind of cloud and rain phenomenon is normal in nature, but excessive rain or drought is abnormal weather. Sweating is the same: normal sweating is a physiological phenomenon, while excessive sweating or complete lack of sweating falls into the pathological category. Sweat is yang water, blood is yin liquid, and yin and yang are interdependent—sweat and blood share the same origin. For this reason, sweat-related syndromes often lead to blood-related syndromes—for example, when one suffers from cold, one should normally relieve it through sweating, but if one cannot sweat, one might resort to nosebleeds instead, which are then considered red sweat. The mechanism behind red sweat is yang invading yin—that is, sweat-related syndromes lead to blood-related syndromes. When yang invades yin internally, it causes nosebleeds; when yang invades yin externally, it causes skin sweat. This kind of skin sweat is called sweat and blood. Treatment for sweat and blood should focus on the Heart and Lungs, since blood is the liquid of the Heart and skin is the union of the Lungs, and the Heart and Lungs are closely related to sweat and blood. Clearing Heart Fire prevents yang from overpowering yin, and regulating the Lungs prevents skin from leaking. Use Liang Xue Di Huang Tang, Dang Gui Liu Huang Tang, and Ren Shen Qing Fei Tang with adjustments. For cases of severe liver fire that drives blood to act recklessly and cause sweat and blood, use Dang Gui Lu Hui Wan with adjustments.
Based on the above discussion, sweat and blood should refer to diffuse skin bleeding, a condition that is rarely seen in clinical practice. Modern medicine often discusses purpura, aplastic anemia, leukemia, and other conditions that involve widespread bleeding of the skin and mucous membranes. Whether these conditions are similar to the sweat and blood described in this article is currently difficult to determine. However, judging from the fact that most treatment formulas for this condition are cooling and hemostatic agents, it is likely that this condition belongs to the category of bleeding disorders in modern medicine.
Blood Arrow
A stream of blood emerges from the pores, shooting out like an arrow, hence the name "blood arrow." It occurs when Heart and Lung Fire are excessively strong, forcing blood out through the pores. Treatment should focus on clearing Heart Fire to eliminate the source of the bleeding, using Liang Xue Di Huang Tang with Pu Huang. It is also advisable to drain Lung Fire to calm the qi of the skin and hair, so that the pores do not leak and the bleeding stops on its own. Use Xie Bai San with Sheng Di, Chan Tui, Bai He, Wu Bei Zi, Huang Qin, Pu Huang, Xing Ren, and Bai Ji for treatment. For cases involving both Heart and Lung, use Sheng Di Huang San.
For cases of excessive bleeding that lead to unconsciousness, the situation is no different from that of nosebleeds accompanied by blood loss and dispersion of qi. Use Du Shen Tang with Fu Pian and Pu Huang, or Dang Gui Bu Xue Tang and Shi Quan Da Bu Tang—either option is acceptable.
External treatment methods: Mix peach blossom powder with water and apply it to the bleeding pores to stop the bleeding. Alternatively, grind Jing Mo (1) into vinegar and apply it. Or sprinkle lime powder and flower pollen powder—both methods are effective.
[Commentary] This condition is likely related to vascular tumors; after rupture, one can take Dan Zhi Xiaoyao San and Liang Xue Di Huang Tang, and externally use flower pollen powder. The author's suggestion of using centipede powder mixed with ginger vinegar for external application is a method worth further observation.
Itch
Scabies, eczema, and other skin conditions characterized by redness, itching, and various manifestations are collectively referred to as "blood itch." They are all caused by blood being disturbed by wind and fire; when the fire is intense, it triggers spots and bumps, and when the wind is strong, it leads to insect infestations and itching. For cases where the fire is intense and painful, use Liang Xue Di Huang Tang with Jing Jie, Chan Tui, Hong Hua, and Xing Ren for treatment. For cases where the wind is strong and causes itching, use He Xue Xiao Feng San for treatment. Understanding the nature of blood itch means that all conditions involving acute wind rash (1), lacquer dermatitis (2), and wind rash (3) fall under the same treatment principles. For cases with heat, the color may be white or yellowish, so add Cang Zhu and Chi Ling to the above two formulas; for cases with cold, add Gui Jian, Ginger, and Da Zao to make the treatment more suitable.
Externally, wash with silver flowers, Chen Ai, Sichuan pepper, and salt boiled water. Also apply Da Feng Dan, which works best when mixed with oil.
[Notes] (1) Acute Wind Rash: Also known as "red wind rash" or "red wind rash." It is an acute, unpredictable skin rash that appears suddenly and disappears just as quickly, similar to hives, but more severe. (2) Lacquer Dermatitis: Dermatitis caused by contact with lacquer. (3) Wind Rash: Wind-rash is a type of rash that occurs when wind is mixed with water rash. Water rash refers to eczema and similar conditions.
[Commentary] This condition falls under eczema, scabies, psoriasis, and various allergic rashes that result from scratching and bleeding. Pain is associated with fire, while itching is associated with wind, so treatment should focus on cooling blood and dispelling wind, using formulas like Liang Xue Di Huang Tang and He Xue Xiao Feng San. Externally, washing with silver flowers, Chen Ai, Sichuan pepper, and salt boiled water is recommended.
Wound Blood
A wound is formed when blood凝结 together—whether due to cold, heat, wind, or dampness, it always involves the凝结 of blood. At the beginning, it is best to散血, so that cold, heat, wind, and dampness leave no trace. Later, one should调脓化毒, which is exactly what is meant by the concept of瘀血化脓 in the section on pus emission. Treatment should focus on托里 (1), ensuring that qi reaches the wound. Therefore, blood turns into pus because the wound is formed by blood凝结, and pus is also formed by blood转化; how can blood turn into pus? It is because qi蒸s the blood, causing it to腐化 into pus. Qi is essentially water, as I have repeatedly explained. Since qi is water, blood also turns into water when it is transformed by qi, but it is not called water—it is called pus because it is transformed from blood and is more concentrated than ordinary water. Once the poison has turned into pus, it will not attack the inside of the body. Before the wound breaks open, qi虚者 find it difficult to蒸s the blood; once it has broken open, even qi实者 find themselves unable to resist the pus, and their qi becomes虚. Therefore, it is necessary to固元 and大补其 qi. This is unrelated to the internal conditions discussed in this book, but since both are blood-related illnesses, they are discussed together to complement each other. When qi迫血, it逆ly leads to吐衄; when blood滞qi, it凝ly leads to疮疽. Those whose qi迫血 should破气 to hòa血, while those whose blood滞qi should破血 to hòa qi. Therefore, for吐衄, one should补血, so that qi平; for疮, one should补气, so that blood行. As for cases where the wound has already broken open, the body is already damaged, and it is completely different from the situation of壅闭 (2). Look at acupuncture:刺期门泻肝,刺肺俞泻气—through a single needle, one can already drain a lot of qi from the body. How much more can be drained from a wound that is already wide open? Clearly, a lot of qi can be drained. Therefore, for all cases after the wound has broken open, one should大补元气, unlike吐衄, where qi盛血虚 only needs to滋血 to平qi, and should not助气 to动血. However, after the wound has broken open, there are still some瘀热未清, so one should not immediately use温补. After the blood has been spilled, there is also a great loss of yang qi, so one should not strictly adhere to cooling. Therefore, for those who have lost blood, one should examine the loss of blood and the corresponding loss of qi, and for those whose yang qi is greatly depleted, use Shi Quan, Yang Rong, Gui Pi, and Shen Fu Tang. For those whose wounds have broken open, strengthening the body is essential, but there are still residual toxins, and many of the above formulas are contraindicated, so doctors should not be overly strict.
For internal treatment of wounds, at the beginning, when the wound is hard and swollen, it is best to散血, using Xian Fang Huo Ming Yin for treatment. For those with cold and no sweat, add Ma Huang; for those with fever and irritability, add Lao Lian and Shi Gao; for those with constipation, add Da Huang. For wounds that are stubborn and stagnant, with signs of yin pathology and no qi to drive the poison, add Gui Zhi Jian, Ginger, and Da Zao. For wounds that are flat and spread out, fearing that the poison will attack from within, add Huang Qi, Da Zao, and Ginger. Since blood凝于 qi, blood行则 qi行, so breaking blood is the best way to regulate qi. If one is dealing with吐衄, it is because qi乘血分之内, and when qi降, blood降; therefore, one should focus on破气, combining internal and external perspectives to gain self-awareness. The primary treatment for all types of sores involving pus drainage is the use of Tuoli Xiaodu San. This is because when blood becomes stagnant and fails to circulate, it is necessary to tonify qi to combat the stagnation, thereby promoting the evaporation and decomposition of the pus and facilitating its rapid rupture. Since sores are essentially a condition arising from blood stasis and qi deficiency, there is a concern that insufficient qi may prevent proper transformation; therefore, it is advisable to tonify qi while simultaneously controlling the blood. In cases of hematemesis or epistaxis, however, qi overcomes the blood, leading to an upward surge of blood; thus, it is essential to calm the qi to regulate the blood—this approach differs from the previous one.
Once sores have ruptured, they are considered to be in a state of deficiency, and it is appropriate to consolidate the original qi to replenish qi, with Neibu Huangqi Tang being the principal formula. Furthermore, if the pus has dried up, this indicates qi deficiency, as qi is essentially water; when qi is insufficient, there is less water, resulting in dryness. Moreover, with insufficient qi, the body cannot effectively expel the pus, causing it to accumulate and form a pus-filled tract. In such cases, Huangqi Jianzhong Tang should be supplemented with honeysuckle, red bean sprouts, and angelica root to address the issue. If the pus is clear, this suggests blood deficiency, as the pus is derived from blood; with less blood, the pus appears clear. In these situations, Danggui Buxue Tang is indicated, and Zhi Gancao Tang with added Huangqi can also be used, along with Yangrong Tang.
It is further stated that after rupture, although the condition is one of deficiency, there may still be residual blood stasis that has not been fully resolved. Therefore, one must avoid overly aggressive tonification, which could lead to retention of toxins. Instead, internal administration of Tuoli Xiaodu San combined with external application of Wujin Gao is recommended. This is analogous to treating blood loss accompanied by blood stasis: one should not simply seal off the area and drive out the enemy. For those whose sores have persisted for a long time and still exhibit pus-filled tracts, the use of Wujin Gao is particularly beneficial. If one merely focuses on opening the wound, allowing internal toxins to erupt, the condition will ultimately fail to heal. This is similar to dry-blood tuberculosis, where internal dry blood exists; unless the dry blood is eliminated, new blood cannot regenerate. Such cases involve both deficiency and excess within the same syndrome. Treating the blood in a deficient state results in further depletion, while tonifying the deficiency only exacerbates the excess (3). Consequently, these conditions are difficult to treat, necessitating a combined approach of attacking and tonifying to exhaust all possible measures.
Furthermore, it is noted that after hematemesis, one should tonify the blood to regulate the qi, whereas after sores and abscesses have ruptured, one should tonify the qi to generate blood. Hematemesis and epistaxis occur in the blood aspect, characterized by excess qi and deficiency of blood, while sores and abscesses arise in the qi aspect, marked by excess blood and deficiency of qi.
External treatment methods include: for reducing swelling, use Yuanzhi Gao, prepared by decocting yuanzhi in alcohol and applying it topically, along with Jinhuang San; for resolving decay and removing blood stasis, roast ba dou until black, grind it into a paste, and name it Wujin Gao; snail shells are also effective. To promote tissue regeneration, prepare a powder of frankincense and myrrh, known as Haifusan, and add pearl powder; Huafu Shengji San is also suitable.
However, these methods alone are insufficient to fully address all aspects of treating sores. Here, we merely present external manifestations to help assess internal conditions, thereby clarifying the nature of blood-related issues in various sores, especially in cases of hematemesis and epistaxis.
[Note]
(1) Tuoli: One of the three major therapeutic approaches in surgical treatment of sores and ulcers, involving the use of methods to tonify qi and blood and support the body's vital energy to facilitate the expulsion of toxins.
(2) Jiǒng: Meaning "far" or "distant."
(3) Treating blood in a deficient state leads to further depletion, while tonifying blood in an excess state only exacerbates the excess: In cases of dry-blood tuberculosis, there is dry blood internally, yet externally the patient presents as having a deficiency syndrome. The underlying pathology is deficiency, but the dry blood itself is excess. From a therapeutic standpoint, if one solely targets the dry blood, the deficient condition will worsen; conversely, if one only tonifies the deficiency, the excess condition will become even more pronounced. Therefore, a combined approach of attacking and tonifying is required.
[Commentary] All cases of sores and ulcers accompanied by bleeding fall under the category of this syndrome. Sores arise from blood stasis, where blood, under the influence of qi, undergoes evaporation and decomposition, ultimately leading to ulceration and pus formation. Modern medicine views pus as a product of white blood cell destruction and disintegration, which aligns with the author's perspective that "blood transforms into pus." Since pus and blood share the same origin, sores may contain pus or blood simultaneously, hence the term "sores and blood." The author states: "When qi forces blood, it causes reverse flow, resulting in hematemesis or epistaxis; when blood stagnates due to qi, it coagulates, leading to sores and abscesses." Qi forcing blood indicates excessive qi and deficient blood, requiring blood tonification, whereas blood stagnating due to qi indicates excessive blood and deficient qi, necessitating qi tonification. Thus, the treatment approaches for sores and abscesses differ from those for hematemesis and epistaxis. For initial stages of sores, it is advisable to employ methods that activate blood circulation, using modified versions of Xianfang Huomeng Yin; for managing pus drainage, tuoli therapy is recommended, i.e., using qi-tonifying methods to facilitate the outward expulsion of toxic substances, typically employing modified versions of Tuoli Xiaodu San; and after sores have ruptured, continued qi tonification is still necessary, with formulas such as Neibu Huangqi Tang, Huangqi Jianzhong Tang, and modified versions of Zhi Gancao Tang being employed. In summary, the treatment of sores and abscesses must focus on strengthening qi while simultaneously addressing blood activation and stasis removal to prevent the situation of sealing off the area and leaving behind lingering pathogens. The author notes: "After rupture, the condition is one of deficiency, yet there may still be residual blood stasis that has not been fully resolved; therefore, one must avoid overly aggressive tonification, which could lead to retention of toxins." Additionally, "After hematemesis ceases, one should tonify the blood to regulate the qi, whereas after sores and abscesses have ruptured, one should regulate the qi to replenish the blood." These are valuable insights gained from the author's clinical experience.
This chapter is prepared for online research and reading; for external materials, please align with original publications and the review process.