Library

[Background Information]
Book: *Yixue Zhongzhong Canxi Lu* (Records of Medical Practice Integrating Chinese and Western Medicine)
Author: Zhang Xichun
Dynasty: Qing Dynasty
Chapter: 36. Warm Disease Accompanied by Hematemesis
Category: Medical Theory

[Original Text Translation]

In Cangzhou, an elderly woman surnamed Wu, over seventy years old, accidentally contracted a warm disease (Wenbing, an exogenous febrile disease) accompanied by hematemesis (vomiting blood).

Etiology Although advanced in age, she still managed household affairs personally. Due to excessive mental exertion, her heart often felt hot. It was late spring; after sweating, she was exposed to wind pathogens. Thus, she contracted a warm disease and developed hematemesis.

Symptoms Within three to four days, there was high fever both on the exterior and interior. Whenever extreme heat accumulated in the chest/heart region, she would vomit one or two mouthfuls of blood. Immediately drinking newly drawn well water stopped the bleeding. The tongue coating was thick white, turning yellow. There had been no bowel movement for three days. The pulse was wiry and long on the left side, and surging and long on the right side, beating five times per breath cycle.

Diagnosis This condition arose because excessive mental labor from household duties caused latent heat in the Heart and Liver. Additionally, external pathogenic heat transmitted into the Yangming Fu organs (specifically the Stomach and Intestines). The combination of these two types of heat forced blood to move recklessly, resulting in hematemesis. However, although the pulse indicated intense heat, the healthy Qi (Zhengqi) was not yet deficient. Despite her advanced age, the condition was treatable. The treatment principle should focus primarily on clearing heat from the Stomach Fu, while simultaneously clearing heat from the Heart and Liver. Once both internal injury-heat and external pathogenic-heat are cleared, the blood will naturally cease to bleed.

Prescription
Sheng Shigao (Raw Gypsum Fibrosum, 3 liang, finely crushed)
Sheng Huai Dihuang (Raw Rehmanniae Radix Praeparata from Huaiqing, 1.5 liang)
Sheng Huai Shanyao (Raw Dioscoreae Rhizoma from Huaiqing, 1 liang)
Sheng Hang Shao (Raw Paeoniae Radix Alba from Hangzhou, 1 liang)
Zhimu (Anemarrhenae Rhizoma, 3 qian)
Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian)
Wu Xijiao (Rhinocerotis Cornu, 1.5 qian)
Guang Sanqi (Notoginseng Radix et Rhizoma from Guangxi, 2 qian, finely crushed)

The eight herbs were processed as follows: The first six herbs were decocted to yield three bowls of liquid. The Xijiao was separately decocted to yield half a bowl of liquid. These were mixed evenly and taken in three divided doses, warmed. After each dose of the decoction, one-third of the Sanqi powder was administered with it.

Outcome After completing the three doses, the bleeding stopped, the fever subsided, and the pulse became calm and regular. However, the bowels remained unopened. Therefore, the dregs of the previous decoction were boiled again for administration. The dregs of the Xijiao were also decocted to extract liquid and mixed into the herbal soup. After the bowels opened, the patient recovered completely.

Commentary In my usual practice using Baihu Tang (White Tiger Decoction), I invariably add Renshen (Ginseng Radix et Rhizoma) for patients over sixty years old. In this case, despite the patient being over seventy, I did not add Renshen because of the accompanying hematemesis. Since Renshen was omitted, I heavily relied on 1 liang of Huai Shanyao (Dioscoreae Rhizoma), utilizing its ability to substitute for Jingmi (Oryzae Semen Germineatum) to harmonize the Stomach, and its capacity to slightly tonify the Healthy Qi, similar to Renshen.